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Home My WebLink About2009-00643 - sewer/water connect i . � CITY OF ORONO PERMIT NO.: 2009-00643 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUEn: 09/29/2009 952 249-4600 FAX: 952 249-4616 ADDRESS : 2100 SHADYWOOD RD PIN : 17-117-23-31-0041 LEGAL DESC : WILEYS PARK LAKE MTKA : LOT 030 BLOCK 001 PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION NOTE: WATER AND SEWER CONNECTION-PIPE SIZE-4 INCHES,MATERIAL-PVC SCHED 40 APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 UP NORTH MECHANICAL WATER CONNECT/DISCONNECT/REPAIR 50.00 43900 ELMCREST AVE P.O.BOX 35 STATE SURCHARGE SEWER&WATER 0.50 HARRIS,MN 55032 TOTAL 100.50 (651)277-0515 OWNER MARHULA,DAREN 2100 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 City approvals,and the State Building Code. This permit is for only the work described and does not grant permission for additional or related work which requires separate permits. All provisions of Iaws and ordinances goveming this type of work shall be compied with whether or not specified herein.This permit will expire and become null and void if wnstruction 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 quired inspections aze reque confo ith e S uilding Code.This permit ay be rev ed any � e for , ise _ / / // � A ermitee Signature Date d By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. f � � FOR CITY USE ONLY. 0,��,�`O City of Orono Date Received: Permit# `r P.O.Box 66 �\ 2750 Kelley Parkway ❑In-House SAC Determination Form Compieted � � � f' Crystal Bay,MN 55323 ' ��'� ��''�G� (952)249-4600 Approved By(If Required): �y�go$ CITY OF ORONO — SEWER & WATER/ GENERAL PERMIT (*Note:Some permits may require approval by the Building Official and/or Public Works Deparhnent*) (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aualication 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 available on the job site. 5. Utility connection permits may be issued to licensed contractors only. 6. Contact the Public Works Deparhnent(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 pernut 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 Apply) ❑ Residential(May Require Approval) ❑ Commercial(Approval Required) ❑ New Connection ❑Additional Connection Re-Connection ❑ Repairs ❑ Disconnect ❑ Water Availability Con ection For Future Hook-Up to Water Job Site/Dwner Information: i Site Address: �--� �� ;-�� L��(� et.�.�� . Owner:�f'�J� ��-t"�. Mailing Address: r,�� <S�;C.riC2,�. c� � City: ��` Zip: a--�j� Z Home Phone: Alternate Phone: Contractor Information: � ,.� Contractor: �/� � �`'L ��% Contact Person: � L'�/'.�-// Gf��S'S F�i'!��'G-9:/�.eS' t�.�/� Address: �G°'�s�OX �� ` State License#: Z��zr —��jf City: S �Zip: Expiration Date: ��' Phone: �� Alternate Phone: ��6� — �y/S' t � s .;,, ,. , .�- . .. � " � �� DETERMINII�G��'�ERMIT��FEES �. � ❑ SAC Charge(2009 Rate=$2,000.00) $ (SAC Charge must accompany all sewer permit applications unless prepaid) (Orono City Staff can determine if applicable) (If not prepaid,a sewer connection permif will not be issued) f Sewer Connect'on/Disconnect/Repair($50.00/Per Stub) $ Pipe size�inches;material��Schd 40 air tested; cast iron ❑ Water Connection/Disconnect/Repair($50.00/Per Stub) $ Pipe size inches;material Schd 40 air tested; copper ❑ Water Availability For Future Hook-Up to Water($50.00) $ Water Availabilitv Exnlanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Depamnent. Required Before Water Connection Permit is Issued: 1. Issue Water Meter&Horn Permit 2. Any Additional Connecrion Fees Paid(If Applicable) Issue Water Connection Pernut: L Collect Permit Fee&Issue Water Connection Permit 1. SUBTOTAL of Permit Requested: $ 2. STATE SURCHARGE $ .50 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 se arate permit. ■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon completion of ineter instaltation. The undersigned hereby applies to the City of Orono far 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 are, true and corre t. "^ �,i A licant:� � PP Date: � G DAT TIME � CITY OF ORONO CALLED IN � 9' INSPECTION NOTICE HEDULED 9' �: � PERMIT NO.��9 _dd�� MPLETED ADDRESS d a �'�-u-�- w OWNER CO R. �Wv �.GL TELEPHONE N0. � ^ � - �' T��— � DESCRIPTION G�G� 1' �� ❑ FOOTING ❑ MECHANICAL RI ❑ EXCAV/GRADING/FILLIN Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETLANDS y ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ TREE REMOVAL Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT v ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP i ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL J ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � � � �P/�'�v S' S �//P �� S�' W a o —�f.n_.c.�.Z—�c.1 " t c��n � S2 c,�Jel� '� 1 I r�1 � �/'c�,� I-�4�S�P T� � ° S � ��v.� /v�.,4.� �-f o�� . W °C i�litlo �O�nec fvr" !�'�� r�uG - � Q �" G�S-�-��'c�ti1 — l�nC� � f�oc,r�c� z � un,c� CI� ��L o �r Su a r�- j ��s-t-�L t.c�A a-cJ" 1 .�nJt' /�G e � �WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLEfE W ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN INSPECTOR WILL REfURN �CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 OwnerlContractor on site: � Inspector. � White CopyllnspectoPs File Canary Copy/Site Notice