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Home My WebLink About2017-00558 - water disconnect CITYOFOR NO * 2017 — rd0558 * 2750 KELLEY P WAY DATE ISSUED: 05/23/2017 � ORONO,MN 5 356- (952) 249-4600 FAX: (�52)249-4616 ADDRESS : 1750 SHADYWOOD RD PIN : 17-117-23-21-0021 LEGAL DESC : SHADY-WOOD : LOT 016 BLOCK 000 PERMIT TYPE : WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION � NOTE: GOES WITH 2O17-00234,CONTRACTOR MISSED FILLING OUT WH N THEY APPLIED FOR SEWER DISCONNECT. WATER DISCONNECT ONLY � I i APPLICANT WATER CONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER&WATER 1.00 STONEWOOD,LLC TOTAL 51.00 153 E LAKE STREET PaymenR(s) WAYZATA,MN 55391- CHECK 14781 51.00 (612)462-4000 Minnesota State License#:BUIL-BC594315 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 acwrding to the approved plans and specifications,applicable City approvals,and the State Building Code. This permit is for only the work described and dces not grant permission for additional or rel8ted work which requires separate permits. All provisions of laws and ordinances goveming this rype 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 conformanc ith the State Building Code.This permit may be ,n revoked at any tim r due caus -a. � �/� _� �. - j � � ��.--�� S� �3 / ppli ignature Dat Issued y Signature Date , ,��1 ��b17-��Z��! �M � ��N�� City of Orono Date Received O� C��rt#Y�_'� �to'�� , P.O.Box 66 2750 Kelley Parkway ❑In-House SAC Determination Form Completed s ,� � Crystal Bay,MN 55323 '"�,�k��0.E� (952)249-4600/Fax(952)249-4616 Approved By(If Required): CITY OF ORONO-SEWER& WATER/GENERAL PERMIT (* Vote:Some permits may require approval by the Building Official and/or Public Works Department*) (ALL PERMITS- Mav be subiect to further review and ma�°not be issued when the apolication 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 wark 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 [b�.Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address: l �S� S FPV��,,�� ,p . D�-d"�UO� ��J Owner: G/�Tc.�E�1 �- V�L� ��}-c.vMailing Address: City: Zip: Home Phone: Alternate Phone: Contractor Information: Contractor: ��/��^-��n LL C Contact Person: T�''1"� ��s� , Address: I�3 �� -�'�S� State License #: City: w►�YL�;-r-�-- Zip: �N Expiration Date: Phone: G,12 �G�- �c=nD Alternate Phone: �o I Z 7`7D ��-3� �' w DETERMINING PERMIT FEES ❑ SAC Charge(2016 Rate=$2,485.00) $ (SAC Charge 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 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 Explanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Department. ReQuired Before Water Connection Permit is Issued: l. Issue Water Meter&Horn Permit 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Connection Permit: L Collect Permit Fee&Issue Water Connection Perrnit 1. SUBTOTAL of Permit Requested: $ �� T�� 2. STATE SURCHARGE $ ] 00 (� �� 3. POSTAGE&HANDLING(Only on Mail-]n Applications) $ .0 , �� 'Q� 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 separatepermit. ■ 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 wark in strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies tha statements made on this application are,true and correct. Applicant: Date: Z 3 �� DA E TIME CITY OF ORONO caLLED IN .�' �,,,�'� INSPECTION O ICE SCHEDULED _�;1LSL PERMRNO. (l�O OMPLETED ADDRESS � �5� �� OWNER TEL ONE NO. �� 7O � CONTRACTOR � � DESCRIPTION �� t~y ❑ FOOTING ❑ DEMO-FINAL ❑ S�PTIC FINAL � ❑ POURED WALL ❑ PLUMBING RI ❑ E CAV/GRADING/FILLING Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ T EE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SI E INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ R TED WALLS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ C PLAINT � ❑ FINAL ❑ WATER HOOK-UP ❑ FO LOW-UP W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FO NDATION/REMOVAL _ � v ❑ DEMO-SITE ❑ SEPTIC INSTALL 2 01NNERICONTRACTOR TO M6ET YiOU: YES_NO � COMMENTS: ��l C�r� S�� Ori sdflr�in.o c 7�d � � O � � O —T � W � Q ► � � ` � � I � J W WOFiKSAT1SFACTORY:PROCEED �ROJECT COMPLEtE W ❑ RRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE�OF OCCUPANCY O O CORRECT WORK,CALL FOR REINSPECTION TEMPOR�RY V BEFORE CaVERIN(i PERMAN�NT ❑CORRECT UNSAFE CONDITION WRHIN HOURS. p pHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �GTATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call br the next inspection 24 rs�n advance.,�952) 2�9-4600 OwnerlContractor on site:, — Inspector: wnne covrnn�sc�or:��s Cm�ry CopylSfb Nofk� i