HomeMy WebLinkAbout2007-P11577 - sewer disconnect � PERMIT
CI?'Y OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: p11577
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952)249-4600 Date Issued: l0/16/2007
SITE ADDRESS: 4205 North Shore Dr Unit#
Mound,MN 55364
P��� 07-117-23-43-0004
DESCRIPTION:
Proposed Use: Residential
Pernut Class: General
Permit Type: Sewer and Water Permit P�t Sub-type(s): Sewer Disconnect
DETAILS:
Approved per resolution#:
Separate pemuts required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 35.00 Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $35.50
APPLICANT: Speck-Tacular Companies OWNER: Mary Jo Peterson
5595 270th Street East 4205 North Shore Dr
Elko,MN 55020 Mound MN 55364
T'HE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN 5TRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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' PLICANT PE E SIGNATURE SSUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Sepric, 1-Sepric) Page 1
OCT/15/2007/MON 01 :22 PM HighmarK Builders FAX No, 9527367545 P, 002
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O�p�,4 CityofOtono DareRec�ved;:_.•:...' ; 'Penait�i:; -4'.•:
P.O.Swc6b . . ..•:;`. .•,, :;;,�;'.. �' �;;•. .:.
1750 IColley Parkvvay ❑ta Hvasg.SAC•'Dote�►inaqon�'o,i�GimpieteiI �
� C�ryscal8�y.lMIlV 55323 .:;•' . ;' :,;:' :,�.,,; ,; :•y, ::.
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CITY OF ORONO—SEWER& WATER/GENERAI.PERNIIT
(�NaEe:Same pamtis raayrequire�t►'vel bythe Buildiag O£ficinl mdlor Public Wml��Pmmunt�)
(A�,L�PEItMI'1'3- Mwy be suefeet to tart6ec ravhew aad may not,ba is:ued when the�to»ttitaldoA is recairedl
C7��.'���1�0� • . .. . .. s� .. . . . . • •
1. You�y spply for utility penaits by maiI or ia peison st the City offiices.
2. Mail�ia applications are subject to the pvsta�e and haadling f�e shown below. ��tt cards w�11
be sent by reriun�neil withm 2 i�usiae6s days.
3. Permits are not valtd nntll you receive a permtt card,
4. Work muat not b�ualese the permit card is available on the job site.
S. Ua11ry connection permi�s a�y be iee��ta liaensed coatractors onl�+.
b. Caatact the public'OVorl�bepartment(952-2�4�+600)for utili�ry swb as-built locati�ma.
b0 NOT EJCCAVATE IIY ANY STREET AND DO NOT TAP ANY MAIN without eYprese
npprova[ot tice Public Works Departmen� Yseuaace of a pacrnit does not gant tbis approvsl.
7. All work must be daae in accordence vvith St�te Code nqu'vomcnts.
8. A11�evork must bz insptctcd bcfo�it is co`uorctl. Ct11(952)249-46d0,7.4+haut natfce reqt�irced.
•° _. � . � . . : � � . �TYPE.OF PERMPr'� .�;;� �- �: ��. .
� • � • .. � • ' . •• • . Check�A11T'hatA' 1� . • ::.:�. •:,.:��' •;� ...
�Residential(May Requite Approvai) 0 Commercial(Appmval Required)
�Naw Connecdaa �e�ction �Re-Cosnea�oa �Repaire �bisc�ect
Job Site`/Owner�Infoim�tiaa: .... . __ , .
. Site AddteBS: d� � � ��`a�`"
Owner. ���` �� �iJ Mailing Address:
City: ���°`S fd t/� Zip:
Home Phone: �� " ��v�'���Altsnaate Phone:
Contiactor Information: . . � ' ' . . � �
Can�ractor: e f� �c� � m_ Cantact Person: ,�uSa�—
Address: ����o�?D�.f� State Lieense#: ���� �
City: ` '`�� Zip:�D�o Expiration Date:
Phone: C�� �_fi,l`�a�-'�o�-� Altern�te Phone: ����77S=�..5�
OCT/15/2007/MON 01 :22 PM Highmark Builders FAX No, 9527367545 P, 003
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p s�,c ch.��zoo�s��=sl,c�s.00� s
(SAC Ch�ge must eccampaay all sewer permit applications ualess p�'epaid)
(Orano City Steff can detetmine if applicable)
(If bot prepaid,a sewer conaectton pernait w�not be lssae�)
Q Se�ver Co�I Dlsconnect/xtepalr(S3S.00/per Stok►� S
Pipe size mc�s;material�,Schd 40 air tested; Caet iion
[]Water Coaneefion/Aisconnect/Repatr(S3S.40/Per Stub $
Pipe size inc�es;material Schd 40 s�C tested;�.] coppar
1. SCJ�TOTAY,of peimit nequested: $
2. 3TAT$SURCI�ARCrE $ .SO
3. pdSTACrE dt HANDLIIVG(Only an Mail-In Applications) $ l�SQ ,
4. TOTAL PERIVQT FLE(Add Liaes 1-3 Abov�) $
^zj�:;:�7'�•.'.y`'�1,�'.ikir,•`e,w��`�`;:`1KLJ��Q nL`y.LL�14aO.�u�11.t'1y7L�AO1�,�-r{`ATLA'1YLLi•1'Ld4l.��f�e�`.x^ ,F�"^�'''v]��:::i'?r:'qS7^�.n••y[•
Y'. .,'�(`O.C;'w 1�.•'.WdC
� WAT�Yt 11��YtS must be picked up and paid for at Orono Ciry Heli,t�ese are on a se�arate permi�.
• 'VH'AT�R 1V�TER3 must be set and ssa[ed by Orono Water Depar�ent (9$Z) Z49-460Q,apoa
comple�.on of ineter installaefob. •
The imd�signed heaeb�r applic�s to tlae City of Orvno for issuance of a Utility Peimit,�grees to do
all work in strict e,�cordar►ce with the ordmaaces of the City and the ragulat�oa� p�tl�e State of
Mianesota,ead cet�es that a]1 st��mcnts made on this applicat�on are,tru�and correc�
Agplicea� bate: � � � � ,
� ��1 ': ��� � � �� �/
I � E 'O� TIME
CITY OF ORONO CALLED IN ��
INSPECTION N TICE SCHEDULED
PERMIT NO. � COMPLETED
ADDRESS �"��� �' ���� �� �
OWNER CONTR. ���..f�CkCL���Ci,'`�
TELEPHONE N0. I� �7 I " '— ��� ����,
� DESCRIPTION �}�'L'�-�� I.� I SC C�I�LT
� ❑ FOOTING � MECHANICAL RI ❑ EXCAV/GRADING/FILLING
y ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETLANDS
Q ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ TREE REMOVAL
Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION
Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS
� ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT
Q ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP
� ❑ PLUMBING Rt ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL
J ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W� ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W ORRECT WORK 8 PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN
INSPECTOR W4LL RETURN
❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (J52� 24J-4600
Owner/Contractor on site:
Inspector. �„ r - �
White Copyllnspector's File Canary CopylSite Notice