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Home My WebLink About2017-00545 - sewer disconnect CITY OF ORONO * Z 0 1 7 — 0 0 5 4 5 * 2750 KELLEY PARKWAY DATE ISSUED: OS/22/2017 � ORONO, MN 55356- s (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2090 SHORELINE DR PIK : 15-117-23-23-0001 LEGAL DESC : CINPLATTED 15 I 17 23 : LOT 000 BLOCK 000 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION NOTE: DISCONNECT ONLY FOR SECONDARY HOUSE(SUMMER HOUSE) APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER&WATER 1.00 TOTAL 51.00 G.S. Meichels Payment(s) 4715 13th Ave So. cRE�tT caxD s2s2 s�.00 Minneapolis, MN 55407 OWNER HEAD, MARTHA 1616 W.22ND STREET MINNEAPOLIS, MN 55405- 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 afrer work has commenced. The applicant is responsible for assuring all required inspections are requested i conformance with the State Building Code.This permit may be „ revoke any time for due ause. _ , /(y� � /� l � �-�� /t�c,�? %`..�_�: �f��J c;, �� i Applicant Permitee Signature Date Issued By Signature Date � � ��0�� City Of OrOIIo Date Rece�o��-�� ' ! ��J�� ; P.O.Box 66 j 2750 Kelley Parkway �In-I�oese SAC Determination Form Completed l�� ,�-� Crystai Bay,MN 55323 � (952)249-4600/Fax(952)249-4616 Approved By(If Rtquired); \�titSH�Q'� . - . - . . CITY OF ORONO-SEWER&WATER/GENERAL PERMIT (*Note:Some pe�mits may require approval by the Building Official and/or Public Works Departrnent') tA.�.L PERMITS- Mav be subiect to turther revitw and mav not be�ssoed when We ao�li�K��+c rr�.,p�� GENF,�tAi,INFORMATiOI� 1. You may apply for utility permits by maii or in person at the City offices. 2. Mailed in applications are subject to the postage and handling fee shown below. Peimit cazds 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(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MA.IN without egpress 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. TYP�OF PER�IT Ch�ck All That A i fl Residential(May Require Approval) ❑ Commercial(Approval Required) ❑ New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Jo� Si�te/Ov�er Ir�or�ation: Site Address: . ✓� �� /'/ � Owner;��?t/�-�Z 1`1�2r✓ Mailing Address: l�� l.. / ��.��{' ,f� City: Zip: � ��.r Home Phone: �/�2- ,�?Z�/�� Alternate Phone: ��2�0--�'��'� Contractvr Information: (� . Contractor: -.) . ��,�� , Contact Person: � ^el�' Address: y,71� /3��iv�� .jo. State License#: Ciiy: /�� Zip;��T'V�Expiration Date: �� ,3�' /� Phone: ��_��(J �-� Alternate Phone: Col�- ��,�- ��-�" .� �7J�1 L�:�Z11Y111�t31�1�V r�i'l�V'Li 1 i"r.[�.S .. . . .. . � r a ❑ 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) �u � � [�Sewer Connectio /Disconnect Repair($50.00/Per Stuti) $ �� Pipe size�inc es;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 Ezplanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Department. RecLuired Before Water Connecrion Permit is Issued: 1. Issue VJater Meter&Horn Permit 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Connecrion 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) $ • 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ `� � C`� ADDITIONAL INFORMATION-WATER METERS ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a senarate 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 cer�'fi�s that all statements made on this application are,true and correct. Applican� "�� Date: � � �f_T_ D TE , T1ME � CITY OF ORONO cnLLED IN � ��—� 7 INSPECTION NOTICE SCHEDULED .� PERMR NO. � COMPLETED nn�F.ss �o�[� �l�1�� ,�� c�L � OWNER TELEPHONE NO.��'�''a� CONTRACTOR �� DESCRIPTION " - "`-' °'�`�"��2�� W ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING O ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ 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 _ � ❑ DEMO-SITE ❑ SEPTIC INSTALL i dWNERlCOKTRACTOR TO MEET Y�W:_YES_NO � COMMENTS: ��y' �� C��'�� '�� " C� t 5l°.�1>i: g r.;� o -��l— `� � �,�� L��' Caitr7�t�S' =�i'te� �. _ � ir, 1<J� 0 W � Q � � W OC � J W KSATISFACTORY:PROCEED PROJECT COMPLETE O � ❑CO ECT WORK 3 PROCEED ❑I UE CERTIFlCATE OF OC(:UPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COA/ERINO PERMANENT ❑CORRECT UNSAFE CONDITION WRHIN HOURS. p pH0T0 TAKEN INSPECTOR WILL RETURN ❑5TOP ORDER POSTED.CALL INSPECTOR ��TATION ISSUED ❑INSPECTION REWIRED.CALL TO ARRANGE ACCESS. Caa for the next inspection 24 hours in advance. (952) 249-4600 OwnerlContractor on site: Inspector: WMb CoPYMspeCtor's FlM C�nary Coppl8lb Notla