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Home My WebLink About2015-01516 - sewer/water disconnect CITY OF ORONO * 2 0 1 5 - 0 1 5 1 6 * _� 2750 KELLEY PARKWAY DATE ISSUED: 12/03/2015 . ORONO, MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 2000 SHADYWOOD RD PIN : 17-117-23-31-0001 LEGAL DESC : GUST S JOHNSONS ADDN : LOT 000 BLOCK 000 PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION NOTE: DISCONNECT ONLY APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 COPPIN SEWER&WATER WATER CONNECT/DISCONNECT/REPAIR 50.00 864 QUAIL PKWY STATE SURCHARGE SEWER&WATER 1.00 WATERTOWN,MN 55388- TOTAL 101.00 Minnesota State License#: SW-57329MR P$yment(s) CHECK 4721 101.00 OWNER Sustainable 9 Holdings LLC 124 MAIN ST SE SUITE#343 MINNEAPOLIS,MN 55414 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 dces 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 wmpied 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 aze requested in conformance with the State Building Code.This permit may be n,n revoked at any time for due cause. ��/Y �. � ' r _ - � �U �,�- 3i 15 Applic t Permit e Si ture Date Issued By Signatur Date FOR CITY USE ONLY ��/�/ City of Orono Date Received: �_� /�JPermit# 7��c:- � P.o.Box 66 ��S �(p ^ � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed �, Crystal Bay,MN 55323 ".`� �� (952)249-4600/Faac(952)249-4616 Approved By(If Required): � `�i.�ir�- CITY OF ORONO-SEWER& WATER!GENERAL PERMiT (*Note:Some permits may require approval by the Building Official and/or Public Works Deparhnent•) (AI,L PF.RMITS- Mav be subiect to further review and mav not be issued when the applicatlon ts received) GENERAL INFORMATION 1. You may apply for utility permits by mail ar 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 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+bour notice required. TYPE OF PERMIT Check All That A 1 � 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: r��- �� i�„��Jr (�`l� Owner: 5�_��.,-_:,�,�,;,�,�� n� Mailing Address: �a.S M�r� s� S�.J City: M,:..��,�..��6•'�S zip: 5,y�� Home Phone: 6�c�•'��I-�1�a1� Alternate Phone: Contractor Information: Contractor: C -! a ��e-� ContactPerson: (�:\\ C��'� Address: �6y r�� .\ n�,.af State License#: �A- �7.�7.`� City: �,�,��(� �or� Zip;�� Expiration Date: \o�• 3�- ��o Phone: ��\�,-�O`�3-�C11`1, Alternate Phone: �. : �� :n �. ,� • ; ��=,��, ��s�} 4. �� K a ❑SAC Charge(2015 Rate=52,485.00) $ (SAC Charge must accompany all sewer pernut applications unless prepaid) (Orono City Staff can determine if applicable) (If not prepaid,a sewer connection permit will not be issued) [�Sewer Connection isc nect Repair(550.00/Per Stnb) $ Pipe size inches;material Schd 40 air tested; cast iron [�,Water Connection Disconnect Repair($50.00/Per 5tub) $ Pipe size inc es;materia Schd 40 air tested; copper ❑Water Availability For Future Hook-Up to Water($50.00) S Water Availabilitv Egolanadon: Contractor installed line to inside of house for future hook-up. 1'his line will be inspected by the Public Works Departrnent. 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 Pernut Fee&Issue Water Connection Permit 1. SUBTOTAL of Permit Requested: $ 2. STATE SURCHARGE $ 1.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERNIIT FEE(Add Lines 1-3 Above) S 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 aet 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 aze,true and correct. Applicant: ,� r�,d Date: �cl-.'' c�.� �� 5�-�- D TIME CITY OF ORONO cnLLED IN �� INSPECTION OTICE SCHEDULED �Z�j/`S PERMR NO MPLET ADDRESS �— OWNER EL ONE N � ^ CONTRACTOR G'�. � DESCRIPTION � '�J�-'�� W ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING 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 J ❑ DEMO-SITE ❑ SEPTIC INSTALL 2 OWNEWCONTRACTOR TO MEET YW:_YES_NO y COMMENTS: � �f'' �% �/ 7�i I�,��, �: �l � � 0 � `�';% , ' i�� r� o , L� W � Q � � : � W -�r. � W � � , W,�L� �u WORK SATISFACTORY:PROCEED PROJECT COMPLETE � �CORRECT WORK�PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECTYI�RK,CALL FOR REINSPECTION TEMPORARY V BEFORE CdVERING PERMANENT ❑(�RRECT UNSAFE CONDITION WITHIN HOURS. p pH0T0 TAKEN INSPECTOR WFLL RETURN ❑(�ATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Cafl for the next inspection 24 hours in advsnoe. (952) 249-4600 OwnerlContractor on site: / t , r�./ Inspector: YVhite CopyMnspecto�'s FlN Cenary CopyfSiM Nofkx