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2017-01259 - sewer/water connect
- CITY OF ORONO * z p� 1 7 - 0 1 z 5 9 * 2750 KELLEY PARKWAY DATE ISSUED: 10/04/2017 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 570 SANDHILL DR PIN : 33-118-23-24-0016 LEGAL DESC : ORONO PRESERVE : LOT 9 BLOCK 1 PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION NOTE: SEWER AND WATER CONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 WATER CONNECT/DISCONNECT/REPAIR 50.00 D.S.M. EXCAVATING STATE SURCHARGE SEWER&WATER 1.00 2916 ENTERPRISE AVE HASTINGS,MN 55033- S.A.C. 0.00 (651)480-1355 TOTAL 101.00 Payment(s) CREDIT CARD 5166 101.00 OWNER OPS Orono LLC 15250 WAYZATA BLVD#101 WAYZATA, MN 55391- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the State Building Code. This permit is for only the work described and does not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances goveming this type of work shall be compied with whether or not specified herein.This permit will expire and become null and void if construction authorized is not commenced within 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any time after work has commenced. The applicant is responsible for assuring all required inspections are requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. � �� �/� . � � ,�- 1�� � � �r,� Applican e rtee Signature f Date Iss e y Signature Date . Cl'Y .'t1ffi�S ONT,�' g�N � City of Orono �te Rux;�eed: Pe�t# � ; P.O.Box 66 2750 Kdley ParkwaY O������ninebi�Form Comple�ted a Crystal Bay,IvW 55323 y`"�,�x�s�04�,� (952)249-4600/Fax(952)249-4616 ApPmu�'ed aY�ff RaNn'�d;l: CITY OF ORONO—SEWER&WATER/GENERAL PERNIIT ("Note:Satu P���Y n9uine approval by the Build'mg Officisl and/or Public Works De�o�t•) (ALL PERM11'S- 1Nav be sabiat tn fnrth �ncview.ed m'v�nt 1M i.....r���.x.....a:...w.�e.�..�, GfiI�TE�t:Ai,INFORMAI'IOl� , . . . 1. You maY aPP13'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 rehun mail within 2 business days. 3. Permits are not valid antil.yon receive a permit card. 4. Work must not begin unless the petmit card is available on the job site. S. Utility conna�ion permits may be issued to licensed contractors only. 6. Contact the Public Works Department(952-249-4600j for utility stub as-buitt locations. DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN wfithout ezpress approval of the Pubtic Works Department. Issuance of a permit does not granf this approval. 7. All work must be done in accordance wim State Code requirements. 8. All work must be inspectrd before it is covered. Call(952)249-4600,24+honr notke reqaired. . TYPE�OF PER�T � . Chi�k�11 That A�: ,. �Residential(May Require Approval) ❑Commercial(Approval Required) �New Connection ❑Additional Connection ❑R�Connection ❑Repairs �Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Jc�� �3te/Owa�In�o�ativn: Site Address: �74 �'A�,��� D,2 , Owner: L�i'���0 jY�L'L�f �i�s� Mailing Address: . City: Zip: Home Phone: Alternate Phone: Cori�r Tn�orm�on: Contractor: /�.�/Z1, �4SU�I+L lN�. Contact Person: �,� ��i�✓L Address: 29 � State License#: City: /�� N. Zip:�� Expiration Date: Phone: G s/ y�o./��� Alternate Phone: L,/7 �/9 y,�y3' ... , ������:� ❑SAC Charge(2015 Rate=52,485.00) $ (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) [�Sewe Connertion Disconnect/Repair($50.00/Per Stuti) $ pipe size '' mches;material�_Schd 40 air tested; cast iron (�Wate onn o Disconnect/Repair(550.00/Per Stub) $ pipe s�ze�_inches;material Schd 40 air tested; coppei' ❑Water Availability For Future Hook-Up to Water(550.00) $ Water Availabilitv Eznlanatlon: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Department. � �p;>; Before Water Connection Permit is Issued: 1. Issue Water Meter&Horn Permit 2. Any Additional Connection Fees Paid(If Applicable) isc�P Water Connection Permit: 1. Collect Pemut Fee&Issue Water Connection Permit 1. SUBTOTAL of Permit Requested: � 2. STATE SURCHARGE $ 1.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) S 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) s ADDITIONAL INFORMATI03�1-�ATER METERS ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a�arate permit. ■ WATER 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, 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: Date: ��� T l�_ ♦ � /tI�//� .r�//�ly� / C 1 �./r (J DATE T1ME �- CITY OF ORONO CALLED IN INSPECTION NOTICE scHE�uLED � //' � PERMIT NO. �7""d� COMPLETE ADDRESS �� -- r� OWNER �j ' TELEPHONE NO.�� //�--9/g-y 3yS CONTRACTOR �� • �/l���n� / �!� � DESCRIPTION W "��� C�1�-�'�a'h �y ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL � ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING O ❑ FOUNDATION WATERPROOF ❑ PIUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT � ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP _ ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL � ❑ DEMO-SITE ❑ SEPTIC INSTALL Q OMINER�COI�TRACTOR TO MEET YW:_TES_NO � Z /i � COMMENTS: � �G/� �-f G ���� S��i;�r d �'C-C,u��- c W � � 5����1�I ��—�d �,��� �� � o � �l� r � �r�SSuI'� �fd'_�i J� �S/`-iiit.c> ,�S ��f�� 0 °C �lJ�.� /' �:.v�j�- I/v�� i.1J! //1 Q i 'tf�--��r' r ,U f L.O � W � � W 1NORK SATISFACTORY`.Pi�CEED �PROJEGT COMPLETE � O CORRECT WORK 3 PROCEED ❑ISSUE CERTIFlCATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COA/ERINO PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. �'�OTO TAKEN INSPECTOR WlLL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �pTATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. 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