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Home My WebLink About2017-01603 - sewer/water disconnect , w l � CITY OF ORONO * 2 P� 1 7 - 0 1 6 0 3 * 2750 KELLEY PARKWAY DATE ISSUED: 12/06/2017 ORONO, MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 1720 SHADYWOOD RD PIN : 17-117-23-21-0019 LEGAL DESC : SHADY WOOD : LOT 000 BLOCK 000 PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION NOTE: SEWER&WATER DISCONNECT APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 WATER CONNECT/DISCONNECT/REPAIR 50.00 BOLLIG&SONS,INC. STATE SURCHARGE SEWER&WATER 1.00 11401 COLJNTY ROAD 3 HOPKINS,MN 55343- TOTAL 101.00 (952)938-4133 Payment(s) CREDIT CARD 9081 101.00 OWNER HANSBERGER,TRAVIS 651 LEXIE CT EAGAN,MN 55123- AGREEMENT AND SWORN STATEMENT . The work for which this permit is issued shall be perfortned according to the approved plans and specifications,applicable City approvals,and the State Building Code. This pertnit is for only the work described and does not gant permission for additional or related work which requires separate pertnits. 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 conswction 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 assuri I required inspections are requested in confprmance with the re Building .This permit may be revoked at a�y;,tlme for due caus ./ .-�� /� -/�� ...- (2�� —/ �� / l.(� /� Applicant Permitee Signature Date Issue y Signature Date Y / � ....�C V0��1�L1 �D�Q�� City of Orono Date Recei�ed: ';� Per�iz# 0�17-0 3 ; P.O.Box 66 j 2750 Kelky ParkwaY ❑In-I�o�sc SAC Decerminption Form Compleud s ,�'J Crystal BsY,MN 55323 ��'�A[sH�4'�G, �952)249-4600/Fax(952)249-4616 Approved BY(If Required�: CITY OF ORONO–SEWER&WATER/GENERAL pERNIIT (*Note:Some pumits may require approval by the Building Official and/or Public Works Departmqrt+) (ALL PERMTIS. Mav be aobierr t�n�.�th��.•.�t�aod mav eot iecnrtl rh�n f6�'nnliwaH t �� GEI�TE�tAi.,INFORMATIOI� 1. You may apply for util'rty 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 yon 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 Department�952-249-4600j for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without ezpress approval of the Pubtic 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. TYi'E O�PER�T Check All That A ❑Residential(May Require Approval) ❑ Commercial(Approval Required) ❑ New Connection ❑Additional Connection ❑Re-Connection ❑Repairs �i�isconnect ❑ Water Availability Connecrion For Future Hook-Up to Water Jo� Si��/Ovvt�er In�m�afion: � � � � � G Site Address: � � � -> t`-� , ` ,- �--t,'��-�; � � x�.._� � Owner: Mailing Address: City: ' ` c :,.-. c, ZIP. �_- � -� �� _ , —� Home Phone: Alternate Phone: Contrac�o.r Information: --� �� i . �::x> ',� � � ` (ti Contractor: ; -� .- � , � Y f Contact Person: � �" �-� �� ..�,, �.��.. Address: � �� --�� 3 State License#: ��; (-,'( Y t/ �3 Ciiy: ��'��-� > Zip;}S��i � Expiration Date: I � � � `� Phone: �1 � Z `� 3�' y � �3 Alternate Phone: �' � � z� 3 `f 2 `i S ( Y � . ... . " . ��a..�J'y�V i J.I+�+*+s 1 � -. . . . ., � ❑ SAC Charge(2015 Rate=52,485.00) $ (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/Disconnect/Repair($50.00/Per Stuli) $ 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) S Water Availabilitv Eanlanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Department. Ra uired Before Water Connection Permii is Issued: l. Issue VJater Meter&Horn 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. STATE SURCHARGE $ 1.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines l-3 Above) $ ADDITIONAL INFORMATIOi�T-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 wi�k�the ordinances af"t�ie City ar�d the regulations of the State of Minnesota, and certifies that all statements made on this app�ication are,true and correct. !�' Applicant: , ` Date: � Z � �� ✓ DATE TIME CITY OF ORONO CALLED IN � INSPECTIO�O'TJ�E � SCHEDULED _L�� PERMIT NO. �" � COMPLEf ADDRESS OWNER TELEPHONE NO.��—y �� CONTRACTOR � � 1 � DESCRIPTION �► S Gc�Y�/�e..�t` � � 4~j ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING V3 ❑ FOUNDATION DRAIN TILE ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ LATHE ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP 41 ❑AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL _ J ❑ DEMO-SITE ❑ SEPTIC INSTALL ? OWNERfCONiRACTOR TO MEET Y�OU:_YES_NO � COMMENTS:T�,�f'��;s�4 S�w P�.�'(�/CQ. � � , � - o P�t"u�G� �� C,/��S�tl�� r��/e, 0 W � ^ � � t,'�-,d 2 G��.� ��., � W � O r W� �,[5 WORKSATISFACTORY:PROCEED ❑PROJECT COMPIETE W�'GORRECT W'ORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY 0 ❑(�ORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECONERING PERMANENT �C:ORRECTUNSAFECONDITIONWITHIN HOURS. ❑pHOTOTAKEN INSPECTOR YVILL RETURN �STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Cail br the next inspection 24 hours in advance. (952) 249-4600 OwnerlCorrtraator on site: `� �' �'� Inspector: WAlte CopyAnspector's File Cenary CopylSfte Notiee