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Home My WebLink About2008-00400 - sewer/water disconnect CITY OF ORONO PERMIT NO.: 2008-00400 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUEu: 1U19/2008 ` 952 249-4600 FAX: 952 249-4616 ADDRESS : 2680 SHADYWOOD RD PIN : 21-117-23-24-0046 LEGAL DESC : SHORE HILLS : LOT O15 BLOCK 000 PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 35.00 KEVITT EXC. INC. WATER CONNECT/DISCONNECT/REPAIR 35.00 3335 PENNSYLVANIA AVE NO CRYSTAL, MN 55427 STATE SURCHARGE SEWER&WATER 0.50 (763)545-3557 TOTAL 70.50 OWNER SEWALL, BARRY 2680 SHADYWOOD RD EXCELSIOR, MN 55331- 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 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 conformance with the Sta[e Building Code.This permit may be revo any time for due cause. � �_ � ��_ ��- /f� J 7 "(/��? �� / � � / O �' -�^�. �, ��_.. �R l��}'1 i.': l'� / / Applicant Permitee Signature Date Issued By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. n �1� � �� FOR CTCY USE ONLY O¢��O City of Orono Date Received: Permit# P.O.Box 66 2750 Kelley Parkway ❑In-House SAC Determinarion Form Completed � •''�'• � Crystal Bay,MN 55323 �, �! '� . A roved B f Re wred r•x�-.o � (952)249-4600 PP Y� 9 �r�oe� CITY OF ORONO—SEWER& WATER/GENERAL PERMIT (*Note:Some permits may require appmval by the Building Of£icial and/o�Public Works Department") (ALL PERMITS Mav be subiect to further review and mav Aot be issued w6eo the anolicAdon is received) GENERAL INFORMATION 1. You may apply for utility permits by mail or in person at the City offices. 2. Mailed in applicarions 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 connecrion 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+hour notice required. TYPE OF PERMIT Check All That A 1 �Residential(May Require Approval) ❑Commercial(Approval Required) ❑New Connecrion ❑Additional Connection ❑Re-Connection ❑Repaus ,�Disconnect Job Site/Owner Information: Site Address: � E Q� � �' � �/� w`'� �� `'� Owner: �<:ii./ 5��v`� // Mailing Address: �3�'8 /'�« � /�� h/ Ur•�t S; N:' �/1/r ll I'�et r �6 � �i � City: Zip: Home Phone: Alternate Phone: C't/�'� 3��'-��'`� � s�g Contractor Information: Contractor: I<<�� t E"��'-'7 Contact Person: � �"�"� �' r`� h Address: �� r" ry s,�I�•.�"`.r State License#: /Y%�f t/Y. � City: ��'� t'� � Zip:5 ry��Expiration Date: ./�/-'✓ � s_r 7 ��r ii Phone: 76�rs"- ��t� Phone: �� ,� ` � � s�"` � �`� 3 f DETERMINING PERMIT FEES Q SAC Charge(2008 Rate=$1,825.00) $ (SAC Chazge 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) �Sewer Connection isconnec Repair($35.00/Per Stub) S Pipe size inches;m Schd 40 air tested; cast iron �Water Connection iscoonect Repair($35.00/Per Stub) $ Pipe size inches;ma Schd 40 air tested; copper 1. SUBTOTAL of Permit Requested: $_ 2. STATE SURCHARGE $ .50 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50 4. TOTAL PERMIT 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 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 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 correct. Applicant: ��v�i ��C� Date: ��— / 7 —" � Reset Form � `� � DATy� TIME " CITY OF ORONO CALLED IN ��/a D�l INSPECTION NOTICE / SCHEDULED i �y -� �� PERMIT NO.o�Ofl=0�� COMPLETED ADDRESS S�TJ !�� OWNER CONTR. TELEPHONE NO. , � .��I" O�'c3.��3 � DESCRIPTION b��J L�� ❑ FOOTING � MECHANIC L RI ❑ EXCAV/GRADING/FILLING Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHOREM/ETLANDS y ❑ INSULATION ❑ WOOD BURNER/FIREPLACE Q ❑ 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 _ ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL J ❑ PIUMBING FINAL ❑ FOUNDATION/REMOVAL Z OWNERICONTRACTOR TO MEET YOU:_YES_NO v�, COMMENTS: � W a j o ��#T' �C� Ne�cJ ,��' 1 c� t n g seweT' � 1 � �� i o � v�.�cc �vtir � tia ° C � �► �( 7,'r� � w � Q � a W � W � � O W� RKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE W ❑COR ECT WORK�PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CANDITION WITHIN HOURS. p pHOTO TAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 OwnedContractor on site: Inspector. � White Copyllnspecto�'s File Canary CopylSite Notice