HomeMy WebLinkAbout2007-P10962 - sewer disconnect PERMIT
CITY �F ORONO e
2750 Kelley Parkway- PO Box 66 Permit Number: P10962
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued:
5/3/2007
SITE ADDRESS: 543 Park La Unit#
Long Lake,MN 55356
P��� 06-117-23-41-0043
DESCRIPTION:
Proposed Use: Residential
Pernut Class: General
Permit Type:
Sewer and Water Permit Permit Sub-type(s): Sewer Disconnect
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: Owner/Self OWNER: Terry Johnson
1�'IN 543 Park La
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 CI'TY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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PLI T PERMITE IG TURE ISSUED BY SIGNATURE
Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
FOR CITY USE ONLY
/�(��\ City of Orono Date Received: Yennit#
P.O.Box 66
��,�,� �� 27�0 Kelley Parkway ❑In,FIouse SAC Determination Form Completed
�,�1` C stal Ba
� ���' �;�' �,�' �Y Y,MN 5�323
��,�o��o i (952)249-4600 Approved By(If Required):
`�-...__:
CITY OF ORONO—SEWER& WATER/GENERAL PERMIT
(*Note:Some pennits may require approval by the Building Ofticial and/or Public Works Department*)
(ALL PERMITS- N(av be subiect to further revicw and mav not be issued when the aoplication is received)
GENERAL 1NFORMATION
;. 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 handlii�g 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(ocations.
DO NOT EXCAVATE IN ANl'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.
TYPE'OF PERMIT
(Check All That A 1
�Residential(May Require Approval) � Commercial(Approval Required)
�New Connection ❑Additional Connection �Re-Connection �Repaics �Disconnect
Job Site/ Owner Information:
S ite Address: � ! J ��'��\ ls�1�1 e
Ownec: e�l c.�C7 (�1 Mailing Address:
City: �D(\c( L.C��e Zip: . 5�.��:�
Home Phone: ��c�—�OC(—�(��� Alternate Phone:
Contractor Information:
Contractor: actl� ��f�`�� Contact Person: �Gl��P ��o�
Address: r7NS ��U�P��7�/e State License #:
City: �./��U�O Zip:�/3Expiration Date:
Phone: �aa� r63—SC-�3 Alternate Phone: 76 3 "a��� 36Y9
DETERMINING PERMIT FEES
� SAC Charge(2007 Rate=$1,675.00) $
(SAC Charge must accompany all sewer pernlit applications unless prepaid)
(Orono City Staff can detennine if applicable)
(If not prepaid,a sewer connection permit will not be issucd)
� 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; 0 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 ]-3 Above) �
ADDITIONAL INFORMATION-WATER METERS
■ WATER NIETERS must be picked up and paid for at Orono City Hall,these are on a senarate permit.
■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon
completion of ineter installation.
The undersigned liereby 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 statei e ts made on this application are, true and correct.
� ��.� '�
Applicant: Date: � �
Reset Form �
A TIME `
CITY OF ORONO CALLED IN ��
INSPECTION N TICF�_ .� _ ,� SCHEDULED ,;, -� %�
PERMIT NO. � ''�aw COMPLETED
ADDRESS S7"3 ��.� �—�
OWNER��r(�f �b�'G�l SUy��CONTR. ✓
TELEPHONE NO. � ��a��-9aa�
� DESCRIPTION S��°(. 1�lSGd'it-1L0� �' �`�1
l� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
� 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
�
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
J 10 PLUMBING FINAL 36 FOUNDATION/REMOVAL
� OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS:
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W WORKSATISFACTORY:PROCEED ❑ PROJECT COMPLEfE
� O CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑CORRECT WORK,CALI FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑ INSPECTION REOUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. �952� 249-46QQ
OwnerlContract�r-atf7si�e:
Inspector. �
White Copyllnspector's File Canary CopylSite Notice