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Home My WebLink About2017-00234 - sewer disconnect � � CITY OF ORONO * Z 0 1 7 — 0 0 2 3 4 * 2750 KELLEY PARKWAY DATE ISSUED: 03/13/2017 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 1750 SHADYWOOD RD P[N : 17-117-23-21-0021 LEGAL DESC : SHADY-WOOD : LOT 016 BLOCK 000 PERMIT TYPE : SEWER PROPERTY TYPE : RES[DENTIAL CONSTRUCTION TYPE : DISCONNECTION NOTE: SEWER DISCONNECTION APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 STONEWOOD, LLC STATE SURCHARGE SEWER&WATER 1.00 153 E LAKE STREET MAIL-IN FEE 2.00 WAYZATA, MN 55391- TOTAL 53.00 (612)462-4000 Payment(s) Minnesota State License#: BUIL-BC594315 CHECK 14644 53.00 OWNER SHAW,GRETCHEN&LYLE 7001 KENESTON DR EDEN PRAIRIE, MN 55346- AGREEMENT AIVD 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 State Building Code.This permit may be revoked at any time for due cause. � � � �r' -e,c �._, � l�-i I_7 Applicant Permitee Signature Date Issued By S ature Date � , RE��IVED F CITY USE ONLY�^ ��nlO City Of Orono y�„ +� q Date Received i Permit# �T/l�—� �� P.O.Box 66 I 1�1� .6 ,� LQ 17 2750 Kelley Parkway ❑In-House SAC Determination Form Completed Crystal Bay,MN 55323 ��,�K�� (952)249-4G00/F��,�N� Approved By(IfRequired): CITY OF ORONO-SEWER& WATER/GENERAL PERMIT (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) (ALL PERMfI'S- Mav be subiect to further review and mav not be issued when the aoolication 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 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 Connection ❑Additional Connection ❑Re-Connection ❑ Repairs ❑ Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address: I?�o S P��p Y��.vo0 ,�1� , ,20�� rti Il� 5�3 (o�}- Owner: G'2►:TC.H1�+� f1-tJjp �� Mailing Address: 7vp r �A�GST�v pe S�� City: �D�� 1�6��-s-�.T}�' Zip: S�3 ��_ Home Phone: �v ��- -3��7� A Iternate Phone: Contractor Information: Contractor: � I S3 � �-�K-� SI Contact Person: I�y`-�-t�►�- �or.�5 � Address: y S�� .� State License #: bL sy � '�1 S City: f� Z� Zip:_�11 Expiration Date: Phone: �� -� 77a'�a-3) Alternate Phone: ��- �-{�(,� �U� �R _ y I I ❑SAC Charge(2016 Rate=$2,485.00) $ (SAC Charge must accompany all sewer pe it applications unless prepaid) (Orono City Staff can determine if applicab ) (If not prepaid,a sewer connection permi will not be issued) �,Sewer Connection/ �sco /Repair($ .00/Per Stub) $ S� Pipe size inc es;mater�al Sch 40 air tested; cast iron ❑Water Connection/Disconnect/Repair($ 0.00/Per Stub) $ Pipe size inches;material Sch 40 air tested; copper ❑Water Availability For Future Hook-Up to ater($50.00) $ Water Availabilitv Explanation: Contractor installed line to inside of house fo future hook-up. This line will be inspected by the Public Wor s Department. R uired Before Water Connection Permit is Issued: 1. Issue Water Meter&Horn Permit 2. Any Additional Connection Fees Pai (If Applicable) Is�ue Water Connection Permit: 1. Collect Permit Fee&Issue Water C nnection Permit 1. SUBTOTAL of Permit Requested: I $ �• �O 2. STATE SURCHARGE $ 1.00 3. POSTAGE&HANDLING(Only on Mail-In A plications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above� $ S"� • o t� ' �DI'�'� ,��Il1T�t��t�l��'i� �� ° , � v ■ WATER METERS must be picked up and paid for at Qrono City Hall,these are on a senarate nermit. ■ WATER METERS must be set and sealed by Orodo Water Department (952) 249-4600, upon completion of ineter installation. The undersigned hereby applies to the City of Orono fo issuance of a Utility Permit,agrees to do all work in strict accordance with the ordinances of th City and the regulations of the State of Minnesota,and certifies that all statements made on thi application are,true and correct. Applicant: Date: 3 / � � pTE i TIME CITY OF ORONO �/� cnLLED IN �_ INSPECTION NOTICE� ��,�'�HEDULED a'D� PERMIT NO. 0�0/`7 �'&��fb MPLETED ADDRESS �? � � 01AINER LE ONE NO��`' 7�� CONTRACTOR � �'� � DESCRIPTION 1 �� y ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADINC,/FILLING Q ❑ FOUNDATION WATERPROOF � PLUMBING FINAL ❑ TREE REMmVAL Z ❑ RADON SLAB Q MECHANICAL RI ❑ SITE INSPBCTION Q ❑ FRAMING � MECHANICAL FINAL ❑ RATED WA4LS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-U _ ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATI�N/REMOVAL v ❑ DEMO-SITE ❑ SEPTIC INSTALL 2 OMINENCOKTRACTOR TO�EET lf�lk_YES_NO � �Y� , /�s �9-.�-0 �!—_�_ � COMMENTS: � C '7� � �� T—� /J",. S-t�U� G1Z G � �lJ� � j_ � � � � i • 0 W ' � Q � W � « � � d O K SATISFACTORY:PROCEED ❑PROJECT COMPLETE ❑CO RECT WORK 8 PROCEED ❑ISSUE CEFiTIFICATE OF OCCUPANCY 0 O CORRECTVYORK��L FOR REIN3PECTION TEMPORAF�Y V BEFORE CONERING PERMANEI�T ❑CORRECT UNSAFE CONDITION WfTHIN HOURS. p pF{pT0 TAKEN � INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. csn ro��ne�ext inspectio�2a no��,aa�►�. (952) 2 9-46�00 o�nc«n��o�sn � �%� C.o,,��n, � � �nspector: �/Y YVhite CopyAnapectorti Fil� Canary CopylSN�Notie�