HomeMy WebLinkAbout2006-P09903 - sewer connection •i
�ITY OF ORONO PERMIT
2750 Kelley Parkway- PO Box 66 Permit Number: po99o3
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued: 5/25/2006
SITE ADDRESS: 3619 North Shore Dr Unit#
Wayzata,MN 55391
PID: 08-117-23-34-0010
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type:
Sewer and Water Permit Permit Sub-type(s): Sewer Connection
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: Larson Plumbing Inc. OWNER: Gary&Sandra Baron
3095 162nd Ln NW 4745 Yorktown Lane N
Andover,MN 55304 Plymouth,MN 55442
THE UNDERSIGNED HEREBY REQUESTS PERMISS(ON 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.
i 7��//�� . /�// i'�> � ���//i� ��/`,'�IJL�-�/ !
� / •
1 7�-�l!_1 � � /- r✓'C�G
APPLICANT ITEE SIGNATURE I�LJE pY S[GNATURE
Copies: 1-File(SignaturesReguired), l-Applicant, 1-MonthlyReports, 1-Assessing,(IfSeptic, 1-Septic) Page 1
,
t
FOR CITY USE ONLY .^ /J �
��� CItV of OI'Ono Date Received: Permit# �C�f7�� I
O� Q P.O.Box 66
❑In-House SAC Detem»nation Form Com leted
��,� 2750 Kelley Parkway P
a
�'��1�,�;�_ Ciystal Bay,MN 55323
�at���.���i�o�o� (952)249-4600 Approved By(If Required):
��xo8
CITY OF ORONO –SEWER& WATER/ GENERA.L PERMIT
(*Note:Some permits may require approval by the Building Official and/or Public Works Department*)
(ALI PERMITS- Mav bc subiect to further review and mav not be issued when thc ann��cation is received)
GENERAL INFORMATION —I
1. You may apply for utility pennits by mail or in person at the City offices.
2. Mailed in ap�lications are subject to the postage and handling fee shown below. Permit cards will
be sent by rettun mail within 2 business days.
3. Permits are not valid until you receive a permit card.
4. Work must not begin unless the pernut card is available on the job site.
5. Utility coimection perinits may be issued to licensed conh•actors oiLy.
6. Contact the Public Works Department(952-249-4600) for utility shib as-built locations.
DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express
approval of the Public Works Department. Issuance of a pemut does not grant this approval.
7. All wark must be done in accordance with State Code requiremcnts.
8. All work must be inspected before it is covered. Call(952)249-4600, 24+hour notice required.
TYPE OF PERMIT
(Check All That Apply)
❑ Residential(May Require Approval) ❑ Commercial(Approval Required)
\
❑ New Connection ❑Additional Connection �Re-Connection ���airs ❑ Disconnect
Job Site/ Owner Information:
�______--
Site Address: S � I� ��'f ��� S�'`'r� �( ` "� _
/' �
Owner: ( >���cy c�-r��;,-�, Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
1 v�.� � �Z��
Contractor: L��'z�% �'' �l�"`�� Contact Person: ��c k � ��
Address: �3��1'S �L� �ii-�--�' State License #: 5 S 3� � ����`�
City: ��� Zip: Expiration Date: (2 1 � �
Phone: (����� 3��(-5V� �( Alternate Phone: _
*
�
DETERMINING PERMIT FEES
❑ SAC Charge(2005 Rate=$1,550.00) $
(SAC Charge must accompany all sewer permit applications unless prepaid)
(Orono City Staff can deternune if applicable)
(If not prepaid, a sewer connection permit will not be issued)
�Sewer Connection/Disconnect/Repair($35.00/Per Stub) $
Pipe size�inches;material Schd 40 air tested; cast iron
❑Water Connection/Disconnect/Repair($35.00/Per Stub) $
Pipe size inches; material Schd 40 air tested; copper
1. SUBTOTAL of Pennit Requested: $
2. STATE SURCHARGE $ .50
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) �
ADDITIONAL INFORMATION—WATER METERS
■ WATER METERS must be picked up and paid for at Orono City Hall, these are on a separate pernut.
■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon
completion of ineter installation.
The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do
all work in strict accordance with the ordinances of the City and the regulations of the State of
Minnesota, and certifies that all statements made on this application are, true and correct.
� �
Applica'nt: ��'� � —� Date: � ��� �
/
DATE TIME
CITY OF ORONO CALLED IN -� -a���
INSPECTION NOTICE SCHEDULED �``-�5-U(p /�%a c• f✓i���,�
PERMIT NO. ���U� COMPLETED
ADDRESS .�L(�� :�,- U/�� �� � -,� 2.
OWNER ^ CONTR. ����5�'lt.
TELEPHONEN0. (�'I� �L�"�� � �� �'1
� DESCRIPTION
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FR,4MING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z04 WALL BD. 1�2 WATER HOO},- P 17 SITE INSPECTION
Q 05 FINAL 41 SGW�EA+IA614- 06 PROGRESS
� 07 DEMO-SITE 27 EPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
i09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOH TO MEET YOU:_YES_NO
� COMMENTS:
� �
�
�
J
O
�
� `
O
�
W
�
Q
�
Z
W
�
W
�
�
d
W ORKSATISFACTORY:PROCEED PROJECTCOMPLETE
� ❑CORRECT WORK&PROCEED � G ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR r7 CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next i pection 24 hours in advance. (g52) 249-4600
.
OwnerlContra si e:
Inspector.
White Copyllnspector's File Canary CopylSite Notice