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Home My WebLink About2010-00427 - sewer connect R ; CITY OF ORONO PERMIT IYO.: 2oiaooa2� 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUED: 06/08/2010 952 249-4600 FAX: 952 249-4616 ADDRESS : 3185 SIXTH AVE N PIN : 28-118-23-32-0006 LEGAL DESC : LJNPLATTED 28 1 18 23 : LOT 000 BLOCK 000 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION NOTE: HOMEOWNER PAID SAC CK- 17359 6/8/2010 KOTHRADE S&W PAID PERMIT FEE CK 15763 6/8/2010 APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 KOTHRADE SEWER& WATER STATE SURCHARGE SEWER&WATER 0.50 12059 WH[TETAIL AVENUE HANOVER,MN 55341 S.A.C. 2,100.00 O TOTAL 2,150.50 Minnesota State License#: 0192 OWNER BRANTINGHAM, HENRY&NANCY 3185 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 gran[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 days at any time after work has commenced. The app{�icar�Lis resporySible for assuring all required inspections are reque�, m conformance w� the State Building Code.This permit may be revo{eeTf�a�any ti - ause. �� '? � �, � ` , '�l/1_—� � , � �?O%� � �� rr. �pp i t'P i gh t e I Date Iss By Signature Date SEPA TE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. � . � FOR�15E ONLY „,¢0 A�\ City of Orono Date Received: D Permit# �DID— ya� `�` P.O.I3ox 66 � Q��' 2750 kelley Parkway ❑ln-House SAC Determination Form Completed � r�*ye �-;'� Crystal Bay,MN 55323 ;� ;�c,`, (952)249-4600 Apptoved By(lf Require�d): �.��xaa, - CITY OF ORONO—SEWER & WATER/GENERAL PERMIT (*Note�Some permits may require approval by the Building Official and/or Public Works Department*) (ALL PERMITS- Mav be subiect to Turther review and mav not be issued when the aoplication is received) CENERAL INF'ORMATION � � � � � I. You may apply for utility permits by mai)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 eapress approval of the Public Works Department. [ssuance 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 "e � ln 1 Owner: � �C !G,{�I, I� n- �> Address: � c��,: b�� f2� z�p: _ Home Phone: Alternate Phone: Contractor Information: � ' C Contractor: � � �Q-�� )�Contact Person: ��Q-�� Address: l�� l �"`StateLicense #: ✓��C� �� City: �Cl/1'l �V� Zip��I Expiration Date: ( � �'b� ' Phone: � � � ` � / d '��U� Alternate Phone: �(�3• o'" � � � /� � . } DETERMINING PERMIT�`��S �SAC Charge(2010 Rate=$2,100.00) $ �� DO � �`� (SAC Charge must accompany all sewer permit applications unless prepaid) (Orono City Staff can determine if applicable) ([f 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 Exalanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Department. Reauired Before Water Connection Permit is Issued: l. lssue Water Meter&Horn Permit 2. Any Additional Connection Fees Paid([f Applicable) (ssue Water Connection Permit: 1. Collect Permit Fee& Issue Water Connection Permit 1. SUBTOTAL of Permit Requested: $ �� ' �� 2. STATE SURCHARGE $ .50 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ J�� 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, upon completion of ineter installation. The undersigned ereby applies to the City of Orono for issuance of a Utility Permit, agrees to do all work in stri t cordance with the ordinances of the City and the regulations of the State of Minnesota, an ce ifies t all state ents made on this application are,true and correct. Applicant: Date:� J/v Res�t t Form DATE TIME ✓ CITY OF ORONO CALLED IN INSPECTION NOTICE SCHEDULED - 10 -'�� PERMIT NO. a?D/D-�D S�a7 COMPLETED ADDRESS `3�S �� • OWNER +�"�n h�� TELEPHONE N0.�3' 9�'�?U�- CONTRACTOR ��Q�- � 4� � DESCRIPTION �y2l•l�i� ��'e�� ,��7 � ❑ FOOTING -- ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILL�NG Q ❑ POURED WALL ❑ FAECHANICAL RI ❑ LAKESHORENVETLANDS 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 i ❑ DEMO-FINAL ❑ SEPTIC INSTALL � HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO � � COMMENTS: /'� S'�r� �'`? ��C� .�Si f� _ , a L��,Lu,d'�c,�� 3d''3 d — �'�/�� 0 t' � -_` u�,�s ,5�a-a 0 � Q L�c►� �O �'�//�T`��%f � �c Z ��i,E- W � W � � d 'WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. ppHOTOTAKEN INSPECTOR WILL REfURN ❑STOP OROER POSTED.CALL INSPECTOR �CITATION ISSUED _ ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Cail for the next inspection 2 urs in advance. (952) 249-4600 OwnedContractor on site:y �/� ��Y` Inspector. �� White Copyllnspector's File Canary CopylSite Notice