HomeMy WebLinkAbout2005-P09457 - sewer/water permit PERMIT
`,CITY OF ORONO Permit Number:
2750 Keliey Parkway- PO Box 66 P09457
' Crystal Bay, Minnesota 55323 Permit Type:
Sewer and Water Permit
(952) 249-4600 Date Issued: 11/29/2005
SITE ADDRESS: 4445 North Shore Dr Unit#
Mound,MN 55364
P I D: 07-117-23-31-0001
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: Westonka Sewer&Water OWNER: James&Margaret Kelly
6501 Co.Rd 15 5240 Nolan Dr.
Mound, MN 55364 Minnetonka,MN 55343
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 REQUI MENTS.
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APPLICAN PERMITEE SIGNATURE ISSUED BY SIGNATURE
Copies: I-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
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• FOR CITY USE ONLY
,��� CitV of OrOnO Date Received: ` - %-C:�Permit# - 1`�/S�
P.O.Box 66
���..,,, O 27�0 Kelley Parkway ❑In-House SAC Determination Form Completed
�y'� �;�`� Crystal Bay,MN 55323
�e�����,�,a�.�o`� (9�2)249-4600 Approved By(If Required):
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CITY OF ORONO —SEWER & WATER/ GENERAL PERMIT
(*;Vote:Some pennits may require approval by the Building Official and/or Public Worhs Department*)
(ALL PFRMITS- Mav be subiect to further revie�v and ma�•not be issued when the�npnlicution is reccived)
GENERAL INFORMATION
1. You may apply for utility pernuts by mail or in person at the City offices.
2. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards will
be sent by return mail wiYhin 2 business days.
3. Permits are not valid until you receive a pernut card.
4. Work must not begin uilless the pernut card is available on the job site.
5. Utility 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 IN ANY STREET AND DO NOT TAP ANY MAIN without espress
approval of the Public Works Department. Issuance of a perinit 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.
TYPE OF PERMIT
(Check All That Apply)
,E]Residential(May Require Approval) ❑ Conunercial(Approval Required)
❑ New Connection ❑Additional Coimection ❑Re-Connection ❑ Repaus ❑ Disconnect
Job Site/ Owner Information:
Site Address: �; 7y j �-i� • i<<���f ��t
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor: �c�'�`V��v y sli,,.i Contact Person: ,�('��c-•'i C%'�'I
Address: /�.�O I Cc`�. ��• (`j State License #: 'c�d�1��'�i
City: , �/�/���✓1� Zip:�'S�� Expiration Date: (��%�GS�
Phone: �7�� y�T S�1 Altenlate Phone: � /� � ?���- �l ���
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- _DETERMINING PERMIT FEES �
❑ SAC Charge(2005 Rate=$1,450.00) $
(SAC Charge inust 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 Perinit Requested: $ �
2. STATE SURCHARGE $ .SO
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
ADDITIONAL 1NFORMATION—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.
Applicant: Date: �/ � � f�5
�� S�- "� DAT/E TIME �
�CITY OF ORONO CALLED IN T/�Z,` ��
INSPECTION NOTICE/,�L/ SCHEDULED ' �� ��C�`-� -����—
PERMIT NO. PO `'7 TS� COMPLETED
ADDRESS �`f�� /�f/ SG'I Ot�P �
OWNER CONTR. I f�p_il�y�,L'�z.
TELEPHONE N0. /5�' `� 7a - y�� �l%
� DESCRIPTION �
lL 01 FOOTWG 11 MECHANICAL RI 18 EXCAV/GR DING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
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O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 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 INSTALL. 22 FOLLOW-UP
? 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
� 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Z OWNER/CONTRACTOR TO MEET YOU:�YES_NO
� COMMENTS:
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GW tIORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
� ❑CORRECT WORK&PROCEED C 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 � CITATION ISSUED
❑ INSPECTION RE�UIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours irt advance. �95Z� Z49-4600
OwnerlContra�io�onrs�te:
Inspector -U
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