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Home My WebLink About2011-00696 - sewer connect CITY OF ORONO PERMIT NO.: 2011-00696 2750 KELLEY PARKWAY '�� y r ORONO, MN 55356- DATE Iss[1En: 07/2U2011 � 952 249-4600 FAX: 952 249-4616 ADDRESS : 2905 SIXTH AVE N PIN : 28-118-23-31-0006 LEGAL DESC : GARDEN GROVE : LOT 002 BLOCK 002 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION � NOTE: PD$]2,530.00 CK ]3284 FOR ASSESSMENT s� !`.�,L, � �� ! G� �� % ��. � � ° t`� � r�,,. APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 WRUCK EXCAVATING, INC. STATE SURCHARGE SEWER& WATER 0.50 15096 102ND ST BECKER,MN 55308 S.A.C. 0.00 (320)267-1855 TOTAL 50.50 Minnesota State License#: 2714 OWNER HAGEN&AGNETA TOTH,JEFFREY 2905 SIXTH AVE N LONG LAKE,MN 55356- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the State Building Code. This permit is for only the work described and does not grant permission for additional or related work which requires separate perniits. All provisions of laws and ordinances governing this type of work shall be compied with whether or not specified herein.This permit will expire and become null and void if construction authorized is not commenced within 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any time after work has commenced. The applicant is responsible for assuring all required inspections are requested in wnformance with the State Building Code.This permit may be revv4ccd-ats�ay.pme for due cause. � � �� j � ��'►�t� l l Applicant Permitee Signature Date Issued B gnature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E. �� f � ., . FOR CITY USE ONLY f ,i" �' ,, City of Orono Date Received: Permit# /%�'��''� r.o.BoX 66 ` �� '", 2750 Kelley Parkway [�In-House SAC�t,e.`rmination Form Completed i �t�'�,� - �� Crystal Bay,MN 55323 s�C- �c�.""�� 1p��$Z � \�y�o (952)249-4600 Approved By(If Required): �� CITY OF ORONO—SEWER & WATER/GENERAL PERMIT (*Note:Some permits may require approval by the Building 08icial and/or Public Works Department*) (ALL PERMITS- Mav be subiect to furthcr review and mav not lx issu�d when tLe aonlication is receivedl GENERAL INFORMATION 1. You may apply for utility permits by mail or in person at the City o�ces. 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 t6e Public�Vorks Deparlment. 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. T'YPE 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: a► ��J �Q`� �11� 6 �DYI O �"ec�-q1 na�cna.1 tn1-5 �FSSoC^I. Owner: k.�QJY1.� (�2�ff'1�U Mailing Address: 1 yo�a 1 �a l .�c S /�leS•f S �'� ��p p� P>ox te5aou 3 City: I .S `��c Zip: �75�1(os Home Phone: Alternate Phone: Contractor Information: Contractor: �,�f 1,(,C��- t-�cw�,Y;;%,E�, ��`'Contact Person: ( ��'► 1/ Address: I 5cR(.� l�Yti:� �� State License#: City: ��CG�i` Zip:55�� Expiration Date: Phone: � ��'��t--G � I ( Alternate Phone: ��-' -�� -�—i�� ' + � DETERMINING PERMIT FEES ❑ SAC Charge(2011 Rate=$2,230.00) $ (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 ConnectiPn/Disconnect/Repair($50.00/Per Stub) $ Pipe size ��inches;materialSc�nSchd 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 Exalanation: Contractor installed line to inside of house for future hook-up. 1'his line will be inspected by the Public Works Deparnnent. Required Before Water Connection Permit is Issued: 1. Issue Water Meter&Horn Pennit 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 $ 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 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 separate permit. • WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, npon 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: �•�-- Date: � " � � �� Iv` � DATE TIME ✓ � CITY OF ORONO CALLED IN � INSPECTION NOTICE QL SCHEDULED 7 -ZS-l I � PERMIT NO. !�� /.CJ COMPLETED ADDRESS �gDS �'J� �^� OWNER TELEPHONE N0.•31�'ZG7—l0 SS CONTRACTOR Lv/�.LLC�-� �ifL�-• >; DESCRIPTION �� '�� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q � POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y � FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP � ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATIOWREMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO v�, COMMENTS: � W a o �� S �. �r,�'' -� �' r � � � l s �s-r�, � 0 � W °` �i� �1 �� v�t.l� /�C� Q z � r�'Sl� �� W � � �LJ� D � ?j �` �� (, S C"`1.SJ� � W�WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE � ❑150RRECT WORK&PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECANDITIONWITHIN HOURS. ppHOTOTAKEN INSPECTOR WILL RETURN �STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED O INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Ca11 for the next inspection 24 hours in advance. (g52) 249-4600 OwnerlContractor on site- Inspector. %�-� � � White Copyllnspecto�'s Ffle Canary CopylSite Notice