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Home My WebLink About2017-00685 - sewer/water connect 1' CITY OF ORONO � � * 2 0 1 7 - 0 0 6 8 5 * 2750 KELLEY PARKWAY DATE ISSUED: 06/22/2017 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 1750 SHADYWOOD RD PIN : 17-117-23-21-0021 LEGAL DESC : SHADY-WOOD : LOT 016 BLOCK 000 PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL COI�TSTRUCTION TYPE : CONNECTION NOTE: WATER AND SEWER RECONNECTION APPLICANT SEWERCONNECT/DISCONNECT/REPA[R 50.00 COPPIN SEWER&WATER WATERCONNECT/DISCONNECT/REPAIR 50.00 864 QUAIL PKWY STATE SURCHARGE SEWER&WATER 1.00 WATERTOWN, MN 55388- TOTAL 101.00 (612)508-9974 Payment(s) Minnesota State License#: SW-57329MR CHECK 5405 101.00 OWNER SHAW,GRETCHEN&LYLE 7001 KENESTON DR EDEN PRAIRIE,MN 55346- AGREEMENT AIYD 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. , ` •. _� ., . .;�, -� 1 ;,�Q `f'-�� /o�oZl � Applicant �ermitee;Signa re Date Issued By ignature Date � . -�.� O C USE ONLY � �-~ ��-��O� City of Orono Date Receive�'� Perinit# D/7 `� ��`r �' •� P.O.Box 66 , � � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed ,�-�' Crystal Bay,MN 55323 �\�`\�t.i',�(�¢j� (952)249-4600/F�(952)249-4616 Approved By(If Required): CITY OF ORONO-SEWER& WATER/GENERAL PERMIT (*Note:Some permits may require approva(by the Building Official and/or Public Works Departrnent') (ALL PERMITS- Mav be subiect to further review and mav not be issued wheo t6e aoolication is received) GENERAL INFOR2vIATION 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 pemvt card is available on the job site. 5. Utility connection permits may be issued to licensed contractors only. 6. Contact the Public Works Deparnnent(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 accardance with State Code requirements. 8. All work must be inspected before it is covered. Call(952)249-4600,24+hour notice required. TYPE OF PERIvIIT Check All That A pi � 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: `1 �C7 ��.v��.i;,,�� D Owner: V f��I,�,�(� ��w Mailing Address: �7 St-�� ,l�c,r�`�.��1 �p City: �:`�:nn Zip: ��3�\ -r--- Home Phone: Alternate Phone: Contractor Information: Contractor: GoQP`� 5�..��w �,J�.al Q� Contact Person: (�`.�.\ cno�: !� Address: �� (��'.� ,�tC,�'f State License#: S7�3 �y- M� City: 1_1�� Zip:S� � Expiration Date: 1�- _��- �� Phone: �\d. • Sn4�-��1`1 Alternate Phone: f . D�'�'F��Tt3 PE�['�FE� ❑ SAC Charge(2015 Rate=$2,485.00) S (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 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) $ Water Availabilitv Egnlanation: Contractor installed line to inside of house for future hook-up. T'his line will be inspected by the Public Works Department. , Reauired Before Water Connecrion Permit is Issued: 1. Issue Water 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 $ ].00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ADDITIONAL INFORMATION-WATER 1�IETERS • WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate permit. ■ WATER METERS must 6e 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: �c t,� M,._ Date: �j '�. �-� � y� DATE TIME � CITY OF ORONO CALLED IN INSPECTION NOTICE SCHEDULED .(p.._�� =bo PERMIT NO.s'��1'�-OO(e�� COMPLETED �_ aooREss I�50 51�IAdv w � O'WNER TELEPHONE NO. �� Z'SK��' CONTRACTOR !�t v� �� I I r � DESCRIPTION � 'F ' � `- 41 ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FIN�AL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAWGR/IbING/FILLtNG O ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REM VAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPE�TION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WA S � ❑ INSULATION �] WOOD BURNERIFIREPIACE ❑COMPLAI � ❑ FINAL �1NATER HOOK-UP ❑ FOLLOW-U i ❑AS BUILT-SURVEY �SEWER HOOK-UP ❑ FOUNDATI WREMOVAL v ❑ DEMO-SITE ❑ SEPTIC INSTALL Z OMMEIUCONTRACT011 TO MEET 1P011:_YES_NO / � � COMMENTS� � D G� . fi� � �� ir �,,�� ^ , �l�A��' '"�i.-- o �5�.�a�s � . � h '� � ` /� � � 4 U� � ! r Q _ 2 � g � W a� � , QG/�IIORKSATISFACTORY: PROJECT COMPL�TE W ❑OORRECT W�C 6 PROCEED O ISSUE CERTIFICA PANCY O� ❑(�ORf�CT NFpRK,CALL FOR F�INSPECTION TEMPC�iARY V BEFORE CO�VERINd PERM/INENT ❑(bqqECT UNSAFE CONDITION YVtTHIN HOURS-�pHpTO TAKEN INSPECTOR VYllt.RE7URN ❑STOP ORDER POSTED.CALL INSPECTOR ❑ ATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. caq ror the next inspection 24 ho�s in adnsnce. (95�) 249-4600 on inspecloe - YVhiN CaPY��W��FlI� C��ry C�P1��Na� �