HomeMy WebLinkAbout2007-P11052 - sewer connection PERMIT
CITY �F ORONO
275�Ke�ley Parkway- PO Box 66 Permit Number: p11052
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Pernut
(952) 249-4600 Date Issued:
5/29/2007
SITE ADDRESS: 543 Park La Unit#
Long Lake,MN 55356
PID: 06-117-23-41-0043
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:
SAC#4443 -06/02/76
FEE SUMMARY: Pernut Fee: $ 35.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: 7akes Excavating OWNER: Terry Johnson
545 Elder Ave 543 Park La
Buffalo,MN 55313 Long Lake MN 55356
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 ORDTNANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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` APPLICANT PERMITE GNATURE [SSUED BY SI ATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
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FOR CITY USE ONLY
O¢��0� City of Ot'ono Date Received: Pennit#
P.O.Box 66
� „��; ti � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed
3 yj'�?�;..;. � Crystal Bay,MN 5�323
a �*�'�'��,o` 952 249-4600 Approved B If Re uired
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CITY OF ORONO—S�WER& WATER/G�NERAL PERMIT
(*Note:Some permits may require approval by the Building OfYicial and/or Public Works Department')
(ALL PERMITS- Mav be subiect to further revicw and mav not be issucd�rohen the anolication is received)
GENERAL INFORMATION
l. 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 tlle 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 1N ANY STREET AND DO NOT TAP ANY MAIN without express
approval of the Public�Vorks 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.
TYPC OF PERMIT
Check All That A 1 )
�Residential(May Require Approval) � Commercial(Approval Rec�uired)
�New Connection � Additionaf Connection �Re-Connection �� Repairs �Disconnect
Job Site/Owner Information:
Site Address: J ! � �/� ( ' �` (��l`� �
Ownec:���Al.,� �Jf> ( I lvfG�"MailingAddress:
City: � � �C " � Zip:
� �� � ��� 7� ��
Home Phone: � � 01 �S U � �� �7qlternate Phone:
Contractor Information:
Contractor: �J�`�F� G�(_ r 5�6ntFict l�erso: c ��'� ���
Address:�Y� �L,QG�� ��� State License #: /t� �f � -Q
City: � ���U Zip.�����Expiration Date:
Phone:��� � �� 3��� Alternate P11one:
1
DETERMINING PERIVIIT FEES '
�SAC Charge(2007 Rate=$1,675.00) $
(SAC Charge inust accompany all sewer perniit applications unless prepaid)
(Orono City Staff can detennine if applicable)
(If not prepaid,a sewer connection permit will not be issued)
�Sewer Connection/Disconnect/Repair($35.00/Per Stub) $
Pipe size�inches; materiay�S�ohd 40 air tested; � cast iron
(
�Water Connection/Disconnect/Repair($35.00/Per Stub) $
Pipe size inches; material Schd 40 air tested; 0 copper
1. SUBTOTAL of Pennit Requested: $
2. STATE SURCHARGE $ .50
3. POSTt�GE&HANDLING(Only on ivlail-In Applications) $ 1.50
4. TOTAL PERMIT FEE(Add Lines I-� Above) $
ADDITIONAL INFORMATION -WATER METERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate permit.
■ W:,"CER 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, a�rees 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: ���'� �
Reset Form
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DATE TIME
�� OF ORONO CALLED IN � �
INSPECTION NOT `,� SCHEDULED ��
PERMIT NO. ��l C��✓' COMPLETED
ADDRESS �'7' I «1�' /� �- ��
OWNER CONTR. �TC� �L-L�/1 r��v
TELEPHONE NO. / � �C% — � �
� DESCRIPTION - �`-�� �
l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
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Q 03 INSULATION 24/25 WOOD BURNER/FIREPLACE 34 TREE REMOVAL
Z 04 WALL BD. 12 WATER HOOK-UP 17 SITE INSPECT�ON
Q OS 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
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU� YES_NO
� COMMENTS:
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W WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLET
� ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFI F Y
W
O ❑ CORRECT WORK,CALL FOR REINSPECTION TE RA
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pHOTOTAKEN
INSPECTOR WILL RETURN
❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTIOtJ REQUIRED.CALLTO ARRANGE ACCESS.
Call for the ne inspection 24 hours in advance. (J52� 24J-46O0
OwnerlCon o i e:
Inspector.
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