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HomeMy WebLinkAbout2016-00611 - sewer/water connect CITY OF ORONO * Z 0 1 6 - 0 0 6 1 1 * � 2750 KELLEY PARKWAY DATE ISSUED: OS/3U2016 � � ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 658 SANDSTONE CIR PIN : 33-118-23-11-0055 LEGAL DESC : STONEBAY : LOT 006 BLOCK 002 PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION NOTE: SEWER AND WATER CONNECTION APPLICANT SEWERCONNECT/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- TOTAL 101.00 (651)480-1355 Payment(s) CREDIT CARD 0444 101.00 OWNER Essay Holdings 2110 LYNDALE AVE S MINNEAPOLIS,MN 55405- 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 governing 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 l80 days of the date of issuance,or if construction is suspended for a period of 180 days at any time afrer 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 caus �'�-� �� . -���� S��l � l Ap icant Permitee Signat Date Issued By ignature Date y RE�EIVED l� / � �� � FOR CITY USE ONLY /��-��10�, City Of 01'Ono �AY � 7 2016 Date Received:J��(P,erm]t# � ��� l� , P.O.Box 66 �`� i ' 2750 Keiley Pazkway ❑In-House SAC Determination Form Com leted ',,y� fi;' Crystal Bay,MN 55323 C�TY OF ORQNp p �.\,����¢F�/ (952)249-4600/Fax(952)249-4616 Approved By(If Required): CITY OF ORONO—SEWER& WATER/GENERAL PERMIT (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) (ALL PERMI'TS- Mav be subiect to further review and mav not be issued when the aoulication is receivedl 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) [�Residential(May Require Approval) ❑Commercial(Approval Required) (�New Connection ❑Additional Connection ❑ Re-Connection ❑ Repairs ❑Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address: rvsg �/►?��'dN� C'/z�'�' Owner: ��BAy ,�GD,2�S � Mailing Address: City: 620�/D Zip: Home Phone: Alternate Phone: Contractor Information: Contractor: Q.�,/�'I, cXG��N� !�✓�� Contact Person: �/�� 1a7�!/�n�,� Address: Z / s� �� State License#: City: '��l.S Zip:5�3,3 Expiration Date: Phone: �i�f' �/�!�18�'S' Alternate Phone: �/� 4/9'�/.3�/� r � � � . � ....� l.7i'i��1 L'ill!'�'�V''��.�� '� "� . . � ... . . . � • ❑ SAC Charge(2015 Rate=$2,485.00) S (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) [�Sewer Connection/Disconnect/Repair($50.00/Per Stuli) S Pipe size � '' inches;material Schd 40 air tested; cast iron [�Water Connection/Disconnect/Repair($50.00/Per Stub) $ Pipe size /'" inches;material Schd 40 air tested; copper ❑Water Availability For Future Hook-Up to Water($50.00) $ Water Availabilitv Egalanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Department. . Required Before Water Connection Permit is Issued: 1. Issue Water Meter&Horn Permit 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Connection Permit: 1. Collect Permit Fee&Issue Water Connection Permit l. SUBTOTAL of Permit Requested: $ 2. STATE SURCHARGE S 1.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMTT 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 senarate 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: ����'�� e � <��- �DATE /� TIME CITY OF ORONO CALLED IN ��� INSPECTION N T CE _��� SCHEDULED �J L� 3.' !/� PERMIT NO. connp�ErE� ___L� ADDRESS �S� �S�VL--� �J OWNER TELEPHONE NO.IP��—Cl/�!'—�3� CONTRACTOR /� C�J � DESCRIPTION �`� `�_� L�Uy'(�Gc-E � ll� ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING O ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP _ ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL v ❑ DEMO-SITE ❑ SEPTIC INSTALL 2 OWNERICONTRACTOR�O�MEEf YOU:_YES_NO _ '�-�� � COMMENTS: //'L l/ ��X W 7�.j2�U/ � t.'�� � f r�G2�"L�,'I/1-Q � �/'�� (��'/'!J �IIOD S,�3l,zE✓�ca J O ). ° �� SC/��D �U � �r-ve'.�:S'pi''U/� t,�:/f �".4C��'' � W i iI.Q Q � � �16,��� �s� �r ,/���,�t�s �-/ � � j d � y�YVORKSATiSFACTORY:PROCEED ❑ PROJECT COMPLEfE W ��CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. �PHOTO TAKEN INSPECTOR WILL REfURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. 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