HomeMy WebLinkAbout2003-P06939 - water connection ITY F PERMIT
C � O RO N O Permit Number:
2750 Kelley Parkway- PO Box 66 P06939
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued: ioi2�i2oo3
SITE ADDRESS: 2765 Pheasant Rd
Excelsior,MN 55331
PID: 21-117-23-23-0025
DESCRI PTION:
Proposed Use: Residential
Pernut Class: General
Permit Type: Sewer and Water Pernut Permit Sub-type(s): Water Connecrion
DETAILS:
Approved per resolurion#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernrit Fee: $ 35.00 Valuation• $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Widmer Inc. OWNER: Stephen Bakke
Box 219 2765 Pheasant Rd
St.Boni,MN 55375 Excelsior MN 55331
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.
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APPLIC PERMITEE SIGNATURE ISSUED BY SIGNATURE
Covies: 1-File(SiQnitures Required),1-Avnlicant, 1-Monthlv Renorts, 1-Assessing, 1-Finance Page 1
(Updated 6/2/03)
CITY OF ORONO APPLICATION FOR UTILITY PERMITS "
. .
Box 66 (2750 Kelley Parkway) SEWER/WATER& SAC
Crystal Bay,1VIN 55323
GENERAI.INFORMATION
1. You may apply for urility pemuts by mail or in person at the City offices.
2. Mailed in applicarions are subject to the postage and handling fee shown below. Permit cards will be sent by return mail the same day
the applicarion is recei�-ed.
3. Permits are not valid until you receive a permit card.
4. Work must not begin unlcss the pemut card is available on the job site.
5. Utility connecrion pemuU may be issued to licensed contractors only.
6. Contact the Public Works Deparnnent(952-249-4600)for utility stub as-built locarions. DO NOT EXCAVATE IN ANY STREET AND '
DO NOT TAP ANY M_�Lv`without express approval of the Public Works Department. Issuance of a pernut does not grant this approval.
7. All work must be done in accordance with State Code requirements.
8. All work must be inspec:ed before it is covered. Call(952)249-4600,24 hoar notice required.
JOB SITE ADDRESS: '`,�l'`� ��!��'��r ��•✓�
Occupancy Type: �- Residential Commercial
Owner's Name: S.L�� 6���� �— Phone Number:
Mailing Address: �J6�— l'iG�=¢-s�.,�-j L�.�L City: Zip:
Contractor's Name:w,c���- Cv'J�'T!/CJr✓tJ �, L�- Phone Number:
Mailing Address: �ss��%y �c-�is �,s���/�r-� City: Zip:
PERMIT TYPE �Connections ❑Repairs ❑Disconnect (Check One)
SAC Charge (2003 rate 51,275.00) $ (Set Rate)
Sac Charge must accompan�-all sewer permit applications unless prepaid.
(If not prepaid, a sewer connection will not be issued)
Municipal Sewer Connecdon/Disconnect/Repair ($35.00 per stub) $
pipe size inches; material Schd 40 air tested; cast iron
Municipal Water Co�nnection/Disconnect/R��e r ($35.00 per stub) $
pipe size�inches; material � copper; other
WATER METERS must be picked up and paid for at City Hall.
Water meters must be set and sealed by Orono `Vater Department
(952-249-4600) upon completion of ineter installation.
REQUIRED minimum setbacks from drain field and septic tanks= 75'
REQUIRED setback from sewer line=20'
PERMIT FEE CALCULATION
1. Subtotal of above permit requested $
2. State Surchar�e $ .50 (Minimum)
The State Building Code Division Surcharge of$.50 per permit must be
included for each well,sea�er and water connection permit requested. �
3. Posta�e & Handling (Only mail-in applications) $ 1.50 (Mail In Only)
4. TOTAL PERNIIT FEE (add lines 1-3 above) $
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 complete, true and correct.
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Signature of Applicant:� � ����-�r-,���-�� Date: f�' �— ����.3
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/ AT �� TIME
CITY OF ORONO CALLED IN � � �u�
INSPECTION NOTJ�'iFr,`� �� SCHEDULED � '� �
PERMR NO. �� ��«� MPLETED U- 1'.b V
ADDRESS � ��� / �P�S�-''`-�
OWNER CONTR. G( ����
TELEPHONE NO. ��� J`��I /Ct��CO
� DESCRIPTION � �ti d ''�
� 01 FOOTING 11 MECHANICAL RI 18 EXCAV/GRADING/FILLING
Q 02 FRAMING 13 MECHANICAL FINAL 19 LAKESHORE/WETLANDS
y 03 INSULATION 24/25 ER/FIREPLACE 34 TREE REMOVAI
Z 04 WALL BD. 12 WATER HOOK- 17 SITE INSPECTION
Q OS FlNAL R HOOK-UP 06 PROGRESS
� 07 OEMO-SITE 27 SEPTIC MAINT. 21 COMPLAINT
v 07 DEMO-FINAL 15 SEPTIC INSTALL. 22 FOLLOW-UP
i09 PLUMBING RI 23 SEPTIC FINAL 35 HARD COVER REMOVAL
J 10 PLUMBING FINAL 36 FOUNDATIOWREMOVAL
2 OWNER/CONTRACTOR TO MEET Y�OU:�YES_NO
h COMMENTS:
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� ❑WORKSATISFACTORY:PROCEED PROJECTCOMPLEfE
W O CORRECT WORK 8 PROCEED UE CERTIFICATE OF OCCUPANCY
p ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
O CORRECTUNSAFECONDITIONWITHIN HOURS. O PHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR O CITATION ISSUED
❑INSPECTION REQUIRED.CALLTO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-46��
OwnerlConUactor on site:
Inspector. � �'�"�
White Copyllnspector's File Canary CopylSite Notice