HomeMy WebLinkAbout2007-P10922 - sewer disconnect PERMIT
CITY OF ORONO
2*750 Kelley Parkway- PO Box 66 Permit Number: P1o922
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued:
4/24/2007
SITE ADDRESS: 3605 North Shore Dr un�t#
Wayzata,MN 55391
PID: 08-117-23-34-0011
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type:
Sewer and Water Permit Pemut Sub-type(s): Sewer Disconnect
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 35.00 Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: FreedomMechanical OWNER: MikeManey
11135 Hwy. 7 3605 North Shore Dr
Watertown,MN 55388 Wayzata,MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF .
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT PERMITEE SIGNATURE SUED BY SIGNATURE
Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
FOR CITY USE ONLY
��(��,`�.\ City Of OI'ono Date Received: Pennit#
P.O.Box 66
�O � O Z750 Kelfey Parkway ❑In-House SAC Determination Form Completed
�� }�'14,`. � Crystal Bay,MN 5�323
�'�',��ny��o` (952)249-4600 Approved By(If Required):
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C�TY OF ORONO—SEWER& WATER/GENERAL PERMIT
(*Notc:Some permits may require approval by the Building OfYicial and/or Public Works Department*)
(ALL PERM1�ITS- Mav be subiect to further review and mav not be issued whe�the�nnlication is reccived)
GENERAL INFORMATION
1. You may apply for utility perinits by mail or in person at the City offices.
2. Mailed in applications are subject to the postage and handling fee shown below. Permit cards will
be sent by return mail within 2 business days.
3. Permits are not valid until you receive a permit c1rd.
4. Work must not begin unless the pennit card is available on the job site.
5. Utifity connection permits may be issued to licensed contractors only.
6. Contact the Public Works Department(952-249-4600)for utility stub as-built locations.
DO NOT EXCAVATE 1N ANY STREET AND DO NOT TAP ANY MAIN without express
approval of the Public�Vorks Department. Issuance of a permit does not grant this approval.
7. All work must be done in accordance with State Code requirements.
8. All work must be inspected before it is covered. Call(952)249-4600,24+hour notice required.
TYPC OF PERMIT
Check All That A 1
�Residential May Require Approval) � Commercial (Approval Required)
S'e�.�we. �.vlf�'
�New Connectiot� ❑Additional Connection o ection �Repair �Disconnect
Job Sitel Owner Information:
Site Address: ,�l�s /Y. s ,� ,��/�
Owner: Mailing Address:
City: Zip: '
Home Phone: Alternate Phone:
Contractor Information:
Contractor: /L%e� �7�� Contact Person: ��� �/��
Address: /l 5 State License #: �'�O`/oZ
City: ou��/ Zip:.S338�j Expiration Date: /��.�/�D T
Phone: ��� 3�3 �l f�'c� Alternate Phone:
DETERMINING PERMIT FEES
[]] SAC Ch;u�ge(2007 Rate=�1,67�.OQ) $
(SAC Charge must accompany all sewer�ernlit applications�mless prepaid)
(Orono City Staff can determine if applicable)
(If not prepaid,a sewer connection permit will not be issued)
�Sewer Connection/ isconnec Rep�ir(535.00/Per Stub) �
Pipe size inche . �terial Schd 40 air tested; 0 cast iron
❑� �Vater Connection/Disconnect/Repnir(�35.00/Per Stub) �
Pipc size inches; material Sclld 40 air tested; 0 copper
1. SUI3TOTAL of Pennit Requested: $
2. STATE SURCHARGE $ .>0
3. POS"1'f1GE&i-lANDLiNG (Oniy on Ylail-In Appiications) S 1.50
4. 'TO'I'AL PGRIIIT FEL, (Add Lines l-� rlbove) �
ADD[�CIONAL INF02MATION -WATER METERS
a ��'ATER�IGTERS must be picked up and paid for at Orono City Hall,thesc are on a s�arate permit.
� W'.41'�R MCTEI�S rnust be set and se�leci_ by Orono �'�'�ter Department (9�21 249-4600, u�on
completion of ineter instaliation.
The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do
all work in strict lccordance with the ordinances of the City and tlle regulations of the State of
Minnesota, and certifies that all stateinents made on this �pplication are, true and coi�rect.
Applicant: 'i��!�C�c Date: ���i� �� �
Reset Form
DATE TIME /
CITY OF ORONO CALLED IN
INSPECTION N TIC SCHEDULED S-3-07 9: 3 a
�RMIT NO. a3 COMPLETED
�"ADDRESS 3��5 ,/VO�-� �f�E�' D�L
OWNER CONTR. ��Do-�►•� V�4ch
TELEPHONE N0.
� DESCRIPTION �5 Cw� �tS G�w N e v'
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTAIL. 22 FOLLOW-UP
i09 PLUMBING Rt 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
� ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
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O ❑CORRECT WORK,CALL FOR REINSPECTIO►J TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Ca11 for the ne inspection 24 hours in advance. (g52) 249-4600
OwnerlCon e:
{nspector.
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