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HomeMy WebLinkAbout2015-00136 - sewer/water connect CITY OF ORONO * Z 0 1 5 - 0 0 1 3 6 * , 2750 KELLEY PARKWAY DATE ISSUED: 02/02/2015 � ORONO, MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 673 SANDSTONE CIR PIN : 33-118-23-11-0039 LEGAL DESC : STONEBAY : LOT 036 BLOCK 001 PERMIT TYPE : SEWER& WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION NOTE: SAC PAID ON NEW HOME PERMIT#2014-01480-Ol/26/15 APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 WATER CONNECT/DISCONNECT/REPAIR 50.00 J.S. STEWART COMPANIES STATE SURCHARGE SEWER&WATER 5.00 11030 LAMONT AVE HANOVER,MN 55341 MAIL-IN FEE 2.00 (763)424-9030 TOTAL 107.00 Payment(s) CHECK 6086 107.00 OWNER Stonebay Builders LLC 14870 BROCKTON LANE DAYTON, MN 55327- AGREEMENT AND SWORN STATEME1vT 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 addi[ional 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 180 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 reques[ed in conformance with the State Building Code.This permit may be revoked at any time for due cause. � 1� , � , � ,� � /'� i �Ct�(,� � ��- � C.`�nCc` � ��- �%s Applicant Permitee Signature Date Issued By Signature Date f---:-�_ FOR�CiTY USE OPiLY ��� �r��,` City of Orono Date Received: �fZ/�P�rmit# �_�_�_�j� pJ1 P.O.Box 66 7—r J V 1 � } 2750 Keiley Parkway ❑In-liouse SAC Determination Form Completed �, 1 Crystal F3ay.MN 55323 ="yt�C� l�d Z�I� ._C�l��C� � ��'�•_."rq��� � (952)244-�600/Fax(952)249-4616 Approved By(lf Required): ����� . r,,,w��r r Y� C1TY OF ORONO—SEWER & WATER/GENERAL PERMiT (*Note:Some pernii[s may reyuire approval by the Building Officiai andinr Puhfic W'orks Depailment*j IAL.L PFRMiTS- Ma�be sub,ject fo 1'urther review and mav not be issued when the anplication is received} � GENERAL INFORMAT[ON i. 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 reiurn maii within 2 business days, 3. Permits are not valid until you receive a permit card. 4. Work must not begin unless the perinit card is availabie on the job site. 5. Utility connection�ernaits rnay be issued to licensed contractor�on1y. 6. Contact the Public Works llepar�ment(952-249-4600}for utility stub as-buift Ioeations. DO NOT EXCAVATE IN ANY STREET'AND DO:yOT TAP ANY MAIN without express approval of the Public Works Department. Issuance of a permit does not grant this approval. 7. All wurk must be dane in accordance with State Code requirements. 8. All work must be inspected before i#is covered. Calt(952)249-4600,24+hour notice required. -- - -- ----- TYPE OF PERMIT - - ------� (Check All That Apply) �Residential(May Require Approval) ❑Commercial (Appruval Required) � � New Connection ❑Additional Connectian [Y] Re-Connection [,_] Repairs [Y] DisconnecY ❑ Water Availability C:'onnectian For Future Hook-Up to Water � Job Site;Owner Information: � Site Address: � � �� ��-�S�-L��Z ��v ��� Owner: ��I;�t�.S�-�`�C:�.c� (�--� Mailing Address: I �(� ?C ������L�C-��v��0.•��- City: �L�I 1�Y� Lip: S.`� ��� 1 Home Phone: 7 4� � `� 7 `1 - �'`f z�= Alternate Phone: Contractor Intorrnation: �� Contractor: �)`,-��L��'�-� �' l�C. Contact. Person: ��a-�� .r Address: l �L� C: 1-tX.VY�..�Y�,� �Y(�.,E State License#: City: �ld,�Y�+l Zip:`���(I Expiration Date: Phone: 7 l� � �Z� (� �'� � Alternate Phone: �� Z ����s' (v C'�`%1 DET�;RMINING PERMIT rEES ❑SAC Charge(2015 Rate=52,485.00) S (SAC Charge must accompany all sewer permit appiications unless prepaid) (Urono City Staff can determine if applicable) (If not p�•epaid,a sewe�•cunnection permit will not be issued) �Sewer Conne•tion/Disconnect/Repair(�50.00lPer Stub) $ `�� f � Pipe size�inches;material � Schd 40 air tested; cast iron �� c..� (�]Water Conn�ction!Disconnect!Repair($SO.00/Per Stub) � Pipe size inches;materiai_`� Schd 4U air tested; capper ❑ Water Availability For x'uture Hook-Up ta Water($50.00) $� � Water Availabilitv Explanation: Contractor installed line to inside of house for future hook-up. This line will be ins}�ected by the Public Works I�epartment. Requircd Before Wntcr Conricctian Pennit is Issued: 1. (ssue Water Meter&Florn I'ennit 2, Any Additianal Com�ection Fees Paid(If Applicable) Issue Water Connection Pennit: l. Collect Permit Fee&Issue Water Connection Permit j c � I. SUBTOTAL of Permit Requested: $ l �d 2. STATE SURCHARGE � 5.00 3. PO5TAGE&HA?�TDLTNG(Only on Mail-In Applications} � 2.00__ c+ .� 4. TOTAi.PERM.['I'F'EE(Add Lines 1-3 Above) $ j f-' 7 _ _- - ------------------- --� ADDIT'IONAL INF4RMATION—WATER 1vIETERS ■ WATF.R METERS must be picked up and paid for at Orono City Hall,these are on a senarate�errnit. ■ WATER MF,TERS must be set and sealed by Orono Water Department (952) 249-4600, apon completion of ineter installation. The undersigned hereby applies to the City of Orono for issuance�f a Utility Permit, agrees to da all work in strict accordanc with the ordinances of the City and the regulations of the State of Minnesota,and c ifies that 'll s tements made on this application are,true and correct. 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W � Q � 2 W .. � W � jr � �oRK SATISFACTORY:PROCEED �ROJECT COMPLETE W�O CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOA �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Cail for the next inspection 24 hours in advance. (g52 249-46�� OwnerfContractor on site: .� � 57�-���"' Inspector_ �L� , White CopyAnspector's File Canary CopylSite Notice