HomeMy WebLinkAbout2006-P10072 - sewer disconnect � PERMIT
CiTY OF ORONO Permit Number:
2'.►,50 Kelley Parkway- PO Box 66 P1oo72
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued:
7/6/2006
SITE ADDRESS: 4209 North Shore Dr Unit#
Mound,MN 55364
P��� 07-117-23-43-0005
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type:
Sewer and Water Permit Permit 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: Westonka Sewer&Water OWNER: William&Mary Titler
6501 Co. Rd 15 2184 Shadywood Rd
Mound,MN 55364 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 BU[LDING CODE REQUIREMENTS.
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'PLICANT PER EE SIGNATURE ISSUED BY SIGNAT[1RE
�•<res Required), 1-Applicant, 1-Monthly Reports, I-Assessing,(If Septic, 1-Septic) Page 1
FOR CITY USE ONLY
� Clty Of OrOnO Date Received: Permit# :
Og �O P.O.Box 66 '
2750 Kelley Parkway ❑In-Hou"se SAC Determination Form Completed
,P� Crystal Bay,MN 55323 � �
��_ ° ' �G�� (952)249-4600 Approved By(If Required):
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CITY OF ORONO—SEWER&WATER/GENERAL PERMIT
(*Note:Some pertnits may require approval by the Building Offtcial and/or Public Works Qepartment")
(ALL PERMITS- Mav be subiect to further review and mav not be issued when the anolication is received)
GENERAL INFORiVIATION ,
1. You may apply for utility pemuts by mail or in person at the City offices.
2. Mailed in applications are subject to the postage and handling fee shown below. Pemut cards will
be sent by retum 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 connection permits may be issued to licensed con�actors only.
6. Contact the Public Works Department(952-249-4600)for utility stub 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 permit does not grant this approval.
7. All work must be done in accordance with State Code requirernents.
8. All work must be inspected before it is covered. Call(952)249-4600,24+hour notice required.
, .TYPE OF FERM�'T
(Check Al1 That A 'ply)
�f�esidential(May Require Approval) ❑Commercial(Approval Required)
❑New Connection ❑Addirional Connecrion ❑Re-Connection ❑Repairs �Disconnect
Job Site/Owner Information: '
Site Address: �'I ��� .��' h � O� �� �
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor: '�'���o��e Sl� Contact Person: ��(,�.�, �I� f�1
Address: ��( �• �N • �5� State License#: ��d�/!��
City: �� `�`� Zip: �36'�Expiration Date: 2 .� �
Phone: �� I �7a'�`�� Alternate Phone: ��� � l c7 �7 /
,
'i�a?���icM ,�I,��5'''z'� t u d'P �1 tf�$ 5.�i c � E` �+ 4 �+�p�,r : �M� k�s ar 'F � r r3i1�� y,
.�'t'':�a r ,�,�� ,i f-. xi �lt' 13d�{`+y��������ti'i�.���-/F+�,?' �„�� � .�:r�r - � .��, }
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❑SAC Charge(2005 Rate=$1,550.00) $
(SAC Charge must accompany all sewer pernut applications unless prepaid)
(Orono City Staff can determine if applicable)
(If not prepaid,a sewer connection permit will not 6e issued)
�wer Connectio isco ct/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 Pemrit 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 INFO�IVIATION—WATER NffMETERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a s�arate permit.
■ 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.
Applicant: Date: � v ��
�'/�
r CITY OF ORONO CALLED IN �"�TF,S� T
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INSPECTION N TICE SCHEDULED 7 �� c�.' �
PERMIT NO. ' �O� COMPLETED
ADDRESS ������ /�`/`� CS�� Ol�� ��,
OWNER CONTR. u..���Siz�����L S d'�(.�
TELEPHONE NO. CS � LI7� �-(�15�
� DESCRIPTION S��-<.:t,1C-�'� 1��5����� �-���
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
� 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
� 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECTION
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Q 05 FINAL 14 SEWER HOOK-UP 06 PROGRESS
� 07 DEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
� 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
= 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W ORKSATISFACTORY:PROCEED .❑ PROJECTCOMPLETE
� ❑CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑CORRECT WORK,CALI FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ PHOTOTAKEN
INSPECTOR WILL RETURN �CITATION ISSUED
G STOP ORDER POSTED.CALL INSPECTOR
C INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �95Z� 249-46QQ
OwnerlContractor ite:
Inspector.
White Copyll�spector's F Canary CopylSite Notice