HomeMy WebLinkAbout2006-P10084 - sewer connect PERMIT
'CITY OF ORONO
Permit Number:
2750 Kelley Parkway- PO Box 66 P10084
-Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued:
7/10/2006
SITE ADDRESS: 645 Old Long Lake Rd Unit#
Wayzata,MN 55391
PID: 36-118-23-32-0004
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: Westonka Sewer&Water OWNER: Kristin&Alistair Jacques
6501 Co. Rd 15 645 Old Long Lake Road
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 BUILDING CODE REQUIREMENTS.
APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
ot
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FOR CITY USE ONLY
¢0 . City of Orono Date Received: Permit#
`Y P.O.Box 66
O4 0 2750 Kelley Parkway 0 In-House SAC Determination Form Completed
a ? Crystal Bay,MN 55323
ii4o of (952)249-4600 Approved'By(If Required):
R s o$,4'
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 subject to further review and may not be issued when the application is received)
GENERAL INFORMATION
1. 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)
Q Residential(May Require Approval) ❑Commercial(Approval Required)
New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect
Job Site/Owner Information:
Site Address: ( (6- aX ) I 1-,A- ..e \e._046
Owner: ,---- d- Cee (AJ Mailing Address:
City: Zip:
Home Phone: 615 2- ick)- 1'11 0 Alternate Phone:
Contractor Information:
(
Contractor: (.,(�.5 ( - Contact Person: e2 14
Address: (c0 ( CO 2d 1 S State License#: 1 8 ( P4 .
City: I14.0()`<-d Zip:g 5 3 6 ifExpiration Date: LZ - ?/- b 6
Phone: qi s 2 `I12 _ qui'i' Alternate Phone: 6/z. -74i i ^ g 7 7 1
';" ' x DETERM]NING PERMIT FEES '
❑SAC Charge(2005 Rate=$1,550.00) $
(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)
ewe. Conn•cti I /Disconnect/Repair($35.00/Per Stub) $
Pipe size ra 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 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 separate 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:U ' 1(k C- Date: 7- 10 - 0(2
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CITY OF ORONO CALLED IN
INSPECTION NOTICE `i SCHEDULED M•'to 3,Gro rbAi
PERMIT NO. P100�7 COMPLETE �Q (J
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OWNER ('CONTR. OeS- u
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TELEPHONE NO. ( / `761/ '1779 ,gn aci-L(c Jf )
DESCRIPTION
W 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
c 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
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O 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
• 04 WALL BD. 12 WATER ••K-UP 17 SITE INSPECTION
Q 05 FINAL 4 SEW - HOOK-UP 06 PROGRESS
07 DEMO-SITE "' - 'AINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
IL 09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
Q OWNERICONTRACTOR TO MEET YOU: YES_NO
a COMMENTS:
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SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W 111ORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
C) ElCORRECT WORK,CALL FOR REINSPECTION TEMPORARY
U BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN
INSPECTOR WILL RETURN
❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-4600
Owner/Contractor on s' e:
Inspector. i
White Copyllnspector's File Canary CopylSite Notice