HomeMy WebLinkAbout2007-P11039 - sewer connection PERMIT
C4 TY OF ORONO
Permit Number:
2750 Kelley Parkway- PO Box 66 P11039
Crystal Bay, Minnesota 55323 Permit Type:
Sewer and Water Permit
(952) 249-4600 Date Issued:
5/23/2007
SITE ADDRESS: 4725 North Shore Dr Unit#
Mound,MN 55364
PID: 07-117-23-32-0017
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: Permit Fee: $ 35.00 Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Coppin Plumbing OWNER: Hessburg Development
5089 Shoreline Dr 4165 Shoreline Drive
Mound,MN 55364 Spring Park,MN 55384
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.
APPLICANT PERMI E GNATURE ISSUED BY SIGNATURE !G//
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
r
FOR CITY USE ONLY
City of Orono Date Received: Permit#
0�� 0 P.O.Box 66
2750 Kelley Parkway ❑In-House SAC Determination Form Completed
Crystal Bay,MN 55323'
(952)249-4600 Approved By(If Required):
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CITY OF ORONO—SEWER& WATER/GENERAL PERMIT
(*Note:Some permits may require approval by the Building Official and/or Public Works Department*)
(ALL PERMITS- May be subiect to further review and may not be issued when the application is received)
GENERAL INFORMATION
I. You may apply for utility permits 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 card.
4. Work must not begin unless the permit 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 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 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)
L3 Residential(May Require Approval) 0 Commercial(Approval Required)
®New Connection [] Additional Connection L21Ce-Connection Repairs 0 Disconnect
Job Site/Owner Information:
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Site Address: � / ;k b) �� U
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information: .
Contractor: C O4 1•wj S a'W Contact Person:
Address: �oNJ State License
City: M t ;S Zip-,� 3S Expiration Date: C 7
Phone: S a 7�'7 3 l� Alternate Phone:
DETERMINING PERMIT FEES
SAC Charge(2007 Rate=$1,675.00) $
(SAC Charge must accompany all sewer permit applications unless prepaid)
(Orono City Staff can determine 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; 0 cast iron
❑Water Connection/Disconnect/Repair($35.00/Per Stub) $
Pipe size inches;material Schd 40 air tested; 0 copper
I
1. SUBTOTAL of Permit 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 stearate permit.
■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon
completion of meter 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: Dat .
Reset Form
DATE TIME
N11
ITY OF ORONO CALLED IN44,
INSPECTION N IC 3 SCHEDULED - 1404
PERMIT NO. COMPLETED
ADDRESS '�7� r��AI
OWNER CONTR.
TELEPHONE NO. 11�( D�
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DESCRIPTION -7
01 FOOTING 11 MECHANICAL RI 18 EXCAWGRADN16FILLINC
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLAND
y 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
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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
i09 PLUMBING RI 23 SEPTI FINAL 35 HARD COVER REMOVAL
v 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
OWNER/CONTRACTOR TO MEET YOU. YES_NO
COMMENTS:
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WORK SATISFACTORY:PROCEED ❑ PROJECTCOMPL� e
W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
CO ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
U BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTOTAKEN
INSPECTOR WILL RETURN
Ll CITATION ISSUED
ElSTOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (J52) 249-4600
Owner/Contractor on site:
Inspector. I C )
White Copy/Inspector's File Canary Copy/Site Notice