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Home My WebLink About2016-00211 - sewer/water connect CITY OF ORONO * 2 0 1 s - 0 a z 1 1 * 2750 KELLEY PARKWAY DATE ISSUED: 03/02/2016 , � 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 : CONNECTION NOTE: SAC GRANDFATHERED IN,HOOKUP 10/30/1968 AND HOME PRIOR. APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 WATERCONNECT/DISCONNECT/REPAIR 50.00 COPPIN SEWER&WATER STATE SURCHARGE SEWER&WATER 1.00 864 QUAIL PKWY WATERTOWN,MN 55388- TOTAL 101.00 Minnesota State License#: SW-57329MR Payment(s) CHECK 4825 101.00 OWNER Sustainable 9 Holdings LLC 124 MAIN ST SE SUIT'E#343 MINNEAPOLIS,MN 55414 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 oniy 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 nuil 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. - a � �''(� - 3 � - � �� ,� i �r � Applicant Permitee Signature Date Issued By Signature Date .. � ,.— FO CI Y USE ONLY ��Z��/�l� City of Orono Date Received�G��`('� Permit# � - (�2�� P.O.E3ox 66 2750 Kelley Parkway ❑In-House SAC Determinatio Form Co�qpleted • �� i � . Crystal Bay,MN 55323 �J�� 7l�L�'�d�j ' � � -'�'\ _ (952)249-4600/Faac(952)249-4616 Approved By(If I�equired): � CITY OF ORONO—SEWER& WATER/GENERAL PERMIT (*Note:Some permits may require approval by the Building Official and/or Public Works Department`) (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aaalication 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 permit card is available on the job site. 5. Utility connection permits may be issued to licensed contractors only. 6. Contact the Public Works Depariment(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 A I ) �Residential(May Require Approval) ❑Commercial(Approvai Required) �New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address: �bQ �,�.�,,,a�r�nJ r�p� '�.h Owner:S,J� `.�,t IQ `��?.�h Mailing Address: �,r�,�, M��;� �,F� S� city: r��>r��c��"�, zip: �5414 Home Phone: b\�-�..�`I -yla� Alternate Phone: Contractor lnformation: Contractor: C K.,��. �w�t�� ux:le( Contact Person: ��\ �.c��0�.t� �1 ' Address: `��,�I Q��.;� �Kw� State License#: sl�o1``•P - M R City: wv;�e��{X„r� Zip�� Expiration Date: �a-3� - �V Phone: �\a-'�r�q�� Alternate Phone: � � F �W 4 _ ' �� t 7 �S �C�3 y= • ,.�i;�'� .�,+F „�,z 'x ,yr"�. s!' � ��.e'� Ra`�x.�"l -`t _i+�'f�. ❑SAC Charge(2016 Rate=$2,485.00) $ (SAC Charge must accompany all sewer permit applicafions unless prepaid) (Orono City Staff can determine if applicable) (If not prepaid,a sewer connection permit will not be issued) �Sewer Connection/Disconnect/Repair($50.0(I/Per Stub) $ Pipe size (.��inches;material Schd 40 air tested; cast iron �Water Connecdon/Disconnect/Repair($50.00/Per Stub) $ Pipe size�,, inches;material Schd 40 sir tested; copper ❑Water Availability For Future Hook-Up to Water($50.00) $ Water Availabilitv Eaplanation: 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&Hom Permit 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Connection Permit: 1. Collect Permit Fee&Issue Water Connection Permit 1. SUBTOTAL of Permit Requested: $ 2. STAT'E SURCHARGE $ 1.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT 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 separate permit. ■ WATER METERS must be set and sesled by Ornno Water Department (952) 249-46011, upon completion of ineter installation. T'he undersigned hereby applies to the City of Orono for issuance of a Urility Pernut,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 a11 statements made on this applicarion are,true and correct. � Applicant: �u.�..� (�n�n;�,; Date: � r�-- �b - � - S�C'�`�f��i�Uor� �� - � DATE TIME CITY OF ORONO CALLED IN INSPECTION N TICE SCHEDULED __��% �'✓� PERMIT NO. '� � �� COMPLETED ADDRESS � �-'��' C l� � OWNER TELEPHON NO. ��-�%��- CONTRACTOR ��/�/G'i��'1 �� DESCRIPTION �'�� `��z� � ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FI L � �!�/��,1 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 Q ❑ FINAL �WATER HOOK-UP ❑ FOLLOW-UP _ ❑ AS BUILT-SURVEY SEWER HOOK-UP ❑ FOUNDATION/REMOVAL J ❑ DEMO- T� ❑ SEPTIC INSTALL 2 OWN ONTRACTOR O MEET YOU:�YES_NO v�i COMMENTS: � .� ►� ► r- .�� , �t'�r lri�n a � r�.� �� 0 � 0 � W � Q � 2 W � W � � � �(WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLEfE W o�CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECWERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN INSPECTOR WILL 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�� Owner�Contracto on site: . �. �� Inspector. �1G+n�'� �� ,��- , White Copyllnspector's File Canary CopylSite Notice