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HomeMy WebLinkAbout2016-00478 - sewer repair � � CITY OF ORONO 2750 KELLEY PARKWAY * 2 0 1 6 - 0 0 4 7 8 * DATE ISSUED: OS/04/2016 ORONO,MN 55356- � (952)249-4600 FAX: (952)249-4616 ADDRESS : 2024 SHADYWOOD RD PIN : 17-117-23-31-0011 LEGAL DESC : GUST S JOHNSONS ADDN : LOT 004 BLOCK 000 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : REPAIR NOTE: SEWER REPAIR APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER&WATER 1.00 WELD&SONS PLUMBING CO INC. MAIL-IN FEE 2.00 3410 KILMER LANE N PLYMOUTH,MN 55441- TOTAL 53.00 (763)475-0296 Payment(s) Minnesota State License#:plbg-PC646375,mech-MB003315 CREDIT CARD 6763 53.00 OWNER KIEFFER,JOHN&BENJAMIN 2024 SHADYWOOD RD WAYZATA,MN 55391- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable Ciry approvals,and the State Building Code. 'I'his permit is for only[he 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 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 wnformance with the State Building Code.This pertnit may be revoked at any time for due cause. . � � / /--� Applicant Permitee Signature Date Issued Signature Date � � � /�� � " " .,in�reY1.�:(c.i;;;�:�i':r'�iifyfP.;' "� �, �N;,i_VA�/1�;(i";''" "'";;I:t{V V �/ � :�L.�11T CAty 0�QXOno ��aE�Receive �'��� ..�,� ., . ': d :s,;� r�� . ,... ��, ���4�4`R.>::.>::��.�.:.���1�-, PA.�ax66 _'.iGfyr:ry;'E,?,.t..:;.: s.; • ,"},,i ,,; '.::;,...,;+,,a;, �i;tl,.:,j;,>; 275U KelleY Parkvray ��.a1,Tn;Tlouse SAQ{, r I' "' �aoA.�x,�a��e�1;',�i, ' c.,�;.,w�� „�, ,� z�.. -� Crystal Bay,MN 55323 ,:;.�`S?It�y.,z+,;;;;,;'",,';;ur"�::a;e%i'�;�i ��`!�"'��s;:"�;1i:?1;,;.;:�;.r,;: K. =' '��,,,�fi(� '�jin�,N%y`"ia'#,� :i_', t (952)2a9-4640/Pax(952)249�616 ,'A,Ppr¢W�d;�Yr��. '�; ��; ':`• 7 � �i: � -°t `ii,"'r T`!R;tux••,r.'�r"y.,/, . ;cw,.'' .� .,r:.�.:..,. axo �:;... .,:.,::,,°r:,:�,.�„ ..,..,: .:�,..:�Y�y,;,: i,:'� r:r;' C�TY OF O�QNO-SEWER&WATE�t/GE�TERAL P�Y�MIT (x Noce:So�e perznits may require approval by cb�e Buildiag Officiel and/or Public wozks Aepsrt�n�ent*) (ALL PERI►2ITS- A'I�v be eubiect M furthar revkw and mav not be isaned when the anDllcatlon la received) ,,.. .. ... .......�.,. .,;, . ..,,,....o.,.._.,�.,..,.........,,...,...�.��:�.,,.,. ;,r;:n;" _ t:as .ry�; � :,�...... . -,: , ., : . �.'.,.,..,....�... ,. ,.... , : �. . , �. d . . ��.. ..�.: .. :drit', :.,,,�,,,. y�,.,:. , �'Ib ,.. =:: ,�: '.��� � �'% . .Q I.�A �� � ...���.:0,�::;. ..�..�...., .., ,:li': �'/..` "t'�, :,'1.,,; , i'.�:.,....�.....�....:.... ...... '.�.I1Hin� .,.� �...��. ... ....,...,...,�....t... . .. . . . '() { ..:;i�i'�';: ,.,.��' �<'t���.:�'.. ���:� I. � �:; �.. . .....i:���.�_w 5��. � ..� : .. ..�'; �.... �... . . .t. . ....��.�:�..�". ::...i::.0�B�u.. 1. You may apply for utility permits by mail or in pez�san at the City offiees. 2. Mai�ed iza ap��ications are subject to t�e postage and laandling fee show�a below. �ermit cards will bc sent by return mail witlaiva 2 bus�iness days. 3. �ermits are not vaGd an�tid you recefve a permit card. 4. Woxl��ust not begin unless fh.e�ezuut card is available on the job site_ 5. U�ility connection pezxaazts zuay be issued to licensed contxactvzs o�ly. 6. Co�tact t1�e Pub�ac Works Deparknent(952-249-46QQ)�or utitity stub as-built lvcat�o�as. DO NOT EXCAVA'I'E IN AN�'S�'�.EET ANb DO N4T'x'.A�,�.ANY MAIN wlthout express a�proval otf the�ablic Works Departmea� Issua.nce o�a pemut does not grant thxs appzoval_ 7. AlI work must be done iz�accrnrda�ace witkZ State Code requiremez�ts. 8. All wrnrk x�aust be�nspected bEfore it is eovered. Ca11(9S2)249-4600,24+hour notiee rec�u��-ed. ,.:.. ,. ........� ..:........ ......::.. - ..1.>"i� �.... ..�.;�;.r.i �:G:.+l��i :I9'/' ' ... .o:� i}(�1'•' ;..y,,,...,��,...,.+:,�-,..,�,�.......... ....e ..... . ,..�, "' T T+ :;if: f� ,a, �...r�.w:��l�.,�i..:.f�...L::� ... ,.. , : ��•- �' �.. :"��.:'� ... .. ............�......, . i ry ��{,� .�.. ��.. �. •� _. � .�.....� �..M: .t.. . . � '.� '.'.. .� .�. . �'.�;:.,��.�.. � . . .'.e'. ' N4!::.'•.r . .�. .� . . .. �.. ..,1. 1.,,4.. .., ,.. ... .. �,....�.,....��...... .. . �J—� �i!—�' . T. , > , , , . ,. .�,.,...,..> , ,,., .......,. . .. ., . .... .- .,.,:....,. ,a,. LL.�'.. ,: .. ,, ._, ,,.,.. .�,,,: ........ ... ...... ........... ....� , .. ,. .., .. ,,,....... ...,. ,�... �;� ,. ..>..,. ...<:.. ...............:. , .... , .�„� . b.. nwl,,,.l�lb,,.,, :. ... ,:, �- .�ti:� ��;•>�;c�: i,;;.°��`_.::,: ,;.,'r';; ,�,.,.:;...,, ..,y,.�...:,��::..,:...;...,..,,,.,..�;�. . ...�.�....:,,.. ._,... n ul: .:i;� �:=d,'tt;,�.� .. :,� ,�. ..... .. ......�. . ..�.,�.-.,....,��:.�. �,, �,�i..: , ...,,.,.. �,� .. ..�. { , ;...;.,..�„ � . .,. . � .. . „.. .�;,.,,,.,�......�.�J�(....�.�.:,. 'j^c'i�; v I, ,,,., . :� "^ ' ,,...y,, ..w., .b�,.r..., .,, �,. : .. ..�� .t . . ... .. �.. ,��, .� � ,,. . �r �� r. ',1:�;�.1 .�, - ��i�ck,E�11'�'hat ., ; i , „ . .. ... ..... .. ...................... ..... .�.... .. ...,. . .: , . ;":�t:;�,� �:;: .,�I��' '!�>:,°.;:,•,;.: ; �� ;, � � �,..,.,.� ;:.. ;,::;=. � ,.,..,_,,...,.� .,.,.... ... �.,�„, . . ...... ...... .. . � .l�, ,;.,�...., . ;. ]�Residen�ial(May Require Approval) �Co�uurnercial{Approval Requared) � . ❑New Couunectiou ❑Additional Connection ❑Re-Con�ection �Repairs ❑Discazun,ect [� water,�A,vai�abi�Zty Coru,ec�ion For�ture Hook-Up to Wate�r y�� M")':", ''„q � � "���r�.,r.a,.,.,,,,:�:T'-;';i S�!;P^;4"."""P"'f'"t.i,es��rn•�. ra.��' �'./�i(] �!f�`b�I118t�lOIl:i „',. . a,�-,�u;as,;n9;3��''•,.n „r.: ,.m�:��.'::i>;hn:�'h� ;:,;!; Site.A,ddress: a Z 5�a.- Le,O QL. Owner: ��✓� �+}�it't� Mailing.A,dd�ess: S�.wr _ City: �ro /�c� Zip: Hv�me Pb�oz�e: d/a.- ,.S�Q ,'��,�5'.A.�tezx�ate�hone: r" 'L w,'�`f±�.75:. ".�7!Mr.'A �;+ ;±i�l�.;u;{�';;.',;�: ._a��:i;�l..��„ .��: .!,i; ::V:� a � r't+r� , � �'` i�;.r;;j ;�,.jp`r � 4; �,.� , ., � •; •: ,. . ;�:.,. ( . . . �., ('� � ,�. n � �Lwv;.hs �..IR;,.,;1 ..e: :Y,a�., ,:.;:a:rr.^E.,.;,..�:;a-"b��2�R.G,`�dr:1�1�4i '��,� L;h.�; ��6..;'1.. Contractor: ar9�la� �Sor1S_��►K� Contact Persan: _7;� Address: 3�i►!D �;Ir+tee- �.,,,�, �(/State L.xcex�se#: pG6�1�3d�� City: ��Jh Zip:� Ex�iration Date: !��3 ��/ � Pha�.e: �d3- �7�•f���,� Alternate Phone: � , ❑Sr�C Charge(ZOX6�t,ate=�2,4$5.00) $ (SA.0 C6arge must accompany all sewer�emait app��catioz�s unless prepaid) (Qrono City StafFcan detez�miaae if appl'zcablc) (Yf not pre�aid,a sewer cvianectio�o peXmit wili nat be issned) �[Sewer Cunnectian/Disconnec epalr SO.00/Per Stnb) S '� Pipe size�inches;xnate�za� c�d 40 sir tested; cast iron . ❑Water Can�ectian/Disconnect/Re�raiur(�SO.ItOl�er Stub) $_ Pipe size iacb�es;lt�ateri.al, Schd 40 air tested; cop�er ❑Water Availability�'ox k'uture Hduk-U�to Water($50.00) $ Wate�r Avaitabilitv Eaolanat�an: Contractor installed line to ins�de of k�ouse�or�utzu�hook-up_ This line wi�l be i�s�cted by the PubIic Works Departmen� Re uired Befare Wate�r Co e 'on Permit is Issued: l. �ssue Watcr Meter&Horn Permit 2. Az�y Additional Cormection Fees Pai�d(If Applxcab[e) Issue Water Cflnnect'ton Permit: 1. Cnllect Permit Fee&�ssue Watez Co�an,ectian Permit 1. S"UBTOTAL of Pernait Requested: � � ' �a 2. STA,�'B SURCHA�QE $ 1.00 3. �OS�'AGB&HANDLTNG(Only on Mai�-�r�.A.��lications) $ 2.00 a, '�O�'.A,�.���T FEE(Add Lines 1-3 Above) $ ��• �� ,,. ..,�,� .�..�..,,,...�,. w � .�:a;,q}u .., t..., r. .. w{:;�,(�;„,,.,�:�.,,!�:; .;,: ...... . :�.,r,�'. ., �',-r•�;:n,I��. . , „. .w'.�.�.:.,�:o:'�� .: o'...; :�„' _.�T : ��.,; ..13'.�,.....,�.'��:.r'r t� .� ,'A;:�`Y `'i;- �i��;�. ' , ;, , , 7-��� � ,n;,,. � ' ' � , . ., F. . . . .,..,o.:,.;.;�... „L1,VD r ■ V�'ATER 1VI��'EktS baust be picked up and paid for at Ocano City Hat�,Lhese are on a senarate permi� ■ WATER METERS mnat be set and sealed by Oronv Water De�art�ment (952} 249�600, upon� . eo�n��e#io�of nr�eter ins�allation. T'he undersigned hereby a���ies to the City of Orono for issuaxxce o�a Ut�lity�ermit,agrees to do all woz� iva stnict accorda�ace with the arditiances o:F th,e Caty a�,d the regulations af the State o;f n innesota,and ee�'tx�ies tb�at a1,�statements made on this appliea�ion axe,tzue ap,d correct. �— / r �f�,, / .A.pp��CSa1t: f"�" DSte: V� r% /� � �';`uk ��.�� :; �� _. � �y' �. `��''� ��5 � - � , � � � �,;.,� �,�'� r , �, ` �, � ^ • � � . ? � �:r,��'�:� ;�:� �"`�` � �, t „ �, �., „ : ��� � . ..,,, � �:� O � � , � � �: . ; od f�. �" � q 'F� . .. ;.: , � �#, • r .. :, �. �,. `'c ,a. ' .w,.,t,.,.0. � +`�B'c ° . � ..� a ` �. � : � " � ..� � .� . _> . . p.:: ,..� :' . r . �` <. .. , . � .�:.„ .Y...- , r,,. ..,�,i,.,. : � .�" , �._ .:.. , ,., .,.�., .,. ....... ,..e. . ..,.,.:: _ :. 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