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2015-00611 - sewer/water connect
CITY OF ORONO * z 0 1 5 - 0 0 6 1 1 * ' 2750 KELLEY PARKWAY DATE ISSUED: OS/15/2015 ' ORONO, MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 681 SANDSTONE CIR PIN : 33-118-23-11-0042 LEGAL DESC : STONEBAY : LOT 039 BLOCK 001 PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION NOTE: SAC PAID#2015-00106 OS/12/15 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 TOTAL 105.00 (763)424-9030 Payment(s) CHECK 6252 105.00 OWNER Stonebay Builders LLC 14870 BROCTON LANE DAYTON, MN 55327- AGREEMENT AND SWORN STATEMEIVT 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 onty 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 hereia 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 re ed any time for du ause. ������ r ,,..v, , }'^ _ - l ,,, s.(J ^'S Cr�� � l`�/�C.'- �� � / � �/ i� � f ica ermit ignature Date Issued By Signature Date ��� A` FOI� •IT SE ONLY ) /� �t/� � � "�-���y City Of OronO Date Received: �7 Permit# L a� �1 P.O.Box 66 j`` � t 2750 Kelley Parkway ❑Tn-House SAC Determination Form Completed �, Crystal Bay,MN 55323 "'� . � (952)249-4600/Fax(952)249-4616 Approved By(if Required): . 4k'FS�� �. � - _ � - CITY OF ORONO—SEWER& WATER/GENERAL PERMIT (*Note:Some permits may require approval by the Buiiding Officiai and/or PvbEic Works Department*) (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoolication is received) 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 pernut card is availabte on the job site. 5. Utility connection pemuts may be issued to licensed contractors only. 6. Contact the Public Works Department(952-249-4600)for utility stub as-buiIt locations. DO NOT E2►CAVATE IN ANY STREET AND DO NOT TAP ANY i11AIN without express approval of the Public Works Department. Issuance of a permit does not grant this approval. ?. All work must be done in accordance with State Code requirements. 8. All work must be inspected before it is covered. Cail(952)249-46U0,24+hour notice required. TYPE OF PERMIT Check All That A 1 �]Residentiai(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: �n�sl ��-����s f-z'r�.� �r�,�� Ownez: ��h p�b Gt.0 �u��,Q t� �, Mailing Address: �� t� 7� i�l'CL'�►� � (,L•�1 Q,,, ci�y: z�p: 5 S 3 2 � Home Phone: Alternate Phone: �� � �r 7�� �.�j L(F, Contractor Information: � r. „ ' ,, � � '�1��,1��" Contractor: �� �l.l,l� ��tL Contact Person: � Address: � � LJ�� �.G�.G�'i��n�}'�11Q�State License#: City: l��L C��V�'v" Zip:S�3`l I Expiration Date: Phone: 7�=:� -'-}Z�—�'1 Dt�(7 Alternate Phone: �.�I Z �(�, iv�§�) DETERMINING PERMIT FEES ❑ SAC Charge(2015 Rate=$2,485A0) $ (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) �c �Sewer Connection/Disconnect/Repair($50.00/Per Stub) $ ��% ' Pipe size " inches;material 5�h yG Schd 40 air tested; cast iron �b�> (�Water Connection/Disconnect/Re air($50.00/Per Stub) $ �� � , � Pipe size � inches;material ���Schd 40 air tested; copper ❑Water Availability Fur Future Hook-Up to Water($50.00) $ Water Availabilitv Exalanation: 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. tssue Water Meter&Horn Permit 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Connection Permit: 1. Collect Permit Fee&lssue Water Connection Permit �L 1. SUBTOTAL of Permit Requested: $ � �� 2. STATE SURCHARGE $ 5.00 3. POSTAGE&HANDLTNG(Only on Maii-Tn Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ � �i-I �-�= � ADDITIONAL INFORMATION—WATER METERS ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate 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 accordartce with the ordinances of the City and the regulations of the State of Minnesota,an,�t certifies thJat al�statements made on this application are,true and conect. / i Applicant: Date: � �/ S - ) 5 e._ ��,�a �� . �� T jY �;�� .�.�^i% S. ^{ . .�i J µ .y� � ��•,. �� �;. a� �.+ �p��,s,d. .*�! , i`���+,_hF ���y-�,� t ���`�. T� ���.�����h,.�� � �`j,t � �' �=�,`._x,��-_' ��� �+,���v �� �, !„-•f��3 id��,✓'.. :,�'� iry "�."��� v� P' � .�i. '� bu t ":1:'4 �r �y;'�'", �'°„� � .:.� � ��s� .�� '�`�S� `r � �r t . ,N � � � ,� , Y , • i, , 's�- ��.: ., �-� ��..� '��. ! 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ADDRESS�:�, .� J�,��S 5�'�`'� �.�.�'�.� OWNER `� ->� � TELEPHONE NO�� �� �`��—1 u..i� CONTRACT R � Li�U � DESCRIPTION ��-�'`e� ` �'I/'l�C''�Yl tl� ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANlCAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ PROGRESS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT J ❑ FINAL � WATER HOOK-UP ❑ FOLLOW-UP W � ❑ AS BUILT-SURVEY �-SEWER HOOK-UP ❑ HARD COVER REMOVAL J ❑ DEMO-SITE ❑ SEP C INSTALL ❑ FOUNDATION/REMOVAL 2 OWNERICONTFiACTOR TO MEET YOU:_ ES_NO c�., COMMENTS: � a t( U C ,�� C1O SPc,�e�'��r c1�Ge.� � w�i� �'Y't4-L��"[.c� ino, 0 � W S / 5 ,�}.�,�' �s f �r- �5' � v� ,���s � /jo � Q � � �/�- ��� �� ����� w��.-, � �-�- �'v�cP w / �'�r c�r w -�e � W �WORKSATISFACTORY:PROCEED �ROJECT COMPLEfE � ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REtNSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN INSPECTOR WILI REfURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-46�0 OwnerlContractor on site: Inspector. White Copyllnspector's File Canary CopylSite Notice