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Home My WebLink About2016-00881 - sewer disconnect 5 aiy CITY OF ORONO * 2 0 1 6 - 0 0 8 8 1 * 2750 KELLEY PARKWAY DATE ISSUED: 07/26/2016 ORONO,MN 55356- (952 249-4600 FAX: (952)249-4616 ADDRESS : 2040 SPATES AVE PIN : 10-117-23-31-0090 LEGAL DESC : ORA PARK ON LAKE MTKA : LOT 000 BLOCK 000 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION NOTE: SEWER DISCONNECTION APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER&WATER 1.00 METRO EARTHWORKS TOTAL 51.00 18950 TERRITORIAL ROAD Payment(s) MAPLE GROVE,MN 55369- CREDIT CARD 6037 51.00 (763)4643512 Minnesota State License#:SW-4531 OWNER DAMMEN,SUSAN 2040 SPATES AVE WAYZATA,MN 55391- AGREEMENT AND SWORN STATEMENT The work for which this pern►it is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the State Building Code. This pennit is for only[he 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.'fhis 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 aze requested in conformance with the State Building Code.This permit may be revoked at time fo e cause. � � L l 25U � l�l �,C� Appl' ant P itee Signatur Date Issued B ignature Date Jul 26 16(11:10p Metro Earthworks 763-428-2212 p.1 _,----..,, �t USE ONLY p ;'$-��l��, City of Orono nare R«xivcq// Pea�rit i��1 �a � P.o.Sox 66 — �r ; 2750 Kclley Parku•ay ❑In-Rouse SAC Determination Fomt Completed s��, .'% Crysta�BaY,MN 55323 _ �`•�C(` �� (952)249-4600;Faa(952)249-4616 Appmved$y(IERequired): \.�4�cyof./ CITY OF ORONU—SEWER& 'WATER/GENERAL PERIVIIT (*Note:Somc pa�s may cr.quirc apptmal by the Bw7ding Officis2 and/or Public Works Depattmcnt') iAiT p�]t�YYTS_Mav be anbi_ect to further revlen��1 m�v not br jtisaed w�en t��n_oliestion j��redl GENERAL 1NFORMATI4N i. You may apply for utility permits by mail or ia person at the City offices. 2. Mailed in applicatioas are subject to the postage and handlmg fee sl�own below. Permit cards will be sent by return cnail within 2 business days. 3. Permits are aot vaiid undl you receive a}�ermit card. 4. Wark must nat begin ualess the permit card is available on the job site. 5. Utility conuection peimits may be issued to licensed contractocs only. 6. Contact the Public Works Department(952-249-460(?)for udlity stub as-bui�t loeatior�s. DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN wit�oat ezpress approval of the Pnblk Works Departmeat. Issuance o£a permit does not grant this aQproval. 7. AI[work must be done in accordance with State Code requirements. 8. AIl wurk must be inspected before it is covered. Cell(95Z)249-4600,24+hour noti�reqaired. TYPB OF PERMIT Check All That A I �dendal(May Require Approval) ❑Commercial(Approva!Requued� Q New Connection ❑Additional Connecrion �e-Connection ❑Repaus Disconnect ❑ Water Availability Connection For Future Hook-Up to Waroer ' -�S't=�;�� ! �c' ��''�`�� "�S Job Site/Owner Information: � `�`�� Site Address: ZC�� .�.�,,�'j %-_ Owner. ; Mailing Address: �a�U c�'i'��f 1F/ City: ✓. :c ' Zip: �l�C�% �4-� �� Home Phone: „fp1 Z '��'�G� Altemate Pltone: Contractor Information: Contractor: �� tl�c� Contact Person: Pl�'' �f lL��•-� Address: /�%✓i� F�`f'•�'�'��'��State�.icense#: � ,f City: < �< ��Zip:-5��ExpirationDate: �� —� Phone: � ,��"��`��.5/� Alternate Phone: Jul 2616 01:11 p Metro Earthworks 763-428-2212 p,2 .. . ... . �,� _: � g . - - ... .. ,, , . , :- , g.y R� x� . .-_'.'� .:*'. .. �.:... . ..:-. . .e�:i': _. ..� ._ �... . _ .. ...... . ...�. . . � • � ; ❑SAC Charge(?A16 Rate=�2,485.00) � (SAC Charge raust accompany all sewer permit applications uniess prepaid) (Orono City Staff can determine if applicable) (If not prepaid,a sewer eonnection permit will aot be issued) �er Connection connect Repair(550.00/Per Stab) S Pipe size imches;matenal Schd 40 air tested; cast imn ❑Water Conneciion/Dlsconnect!Repair(SSO.00/Per Stub) $ Pipe size inches;matesial Schd 40 air testecl; eoppex ❑Water Availability For Future Hook Up to Water($SII.00) � Water Availabil[tv Eznlaaatioo: Contractor installed liQe to inside of house foc future hook-up. This line will be inspected by the Public Works Deparhnent. Reqw't�ed Be�a,�e Water Coimection Femut is Issaed: 1. Issue Water Meter&Horn Permit 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Conneetion PermiG 1. Collect Permit Fee&Issue Water Connectian Petmit 1. SIJBTOTAI,of Permit Requested: $ 2. STATFs SURCHARGE $ i.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAI.PERMIT FEE(Add Lines l-3 Above) S .ADDITIOtVAL INFORMAT�ON—WATER METERS ■ VE'ATER�iETER5 musE be picked up a�d paid for at arona Ci�y HaII,these are on a seoazate permit. ■ WATER METERS must be set and sealed by Orono W�ter Department(952)249-4600, upen completion o!meter installatian. The undersigned hereby apglies to the City of Orono for issuance of a Utilify Pertnit,agrees to do all work in strict accordance with the ordinances of the City and the reguiations of the State of Minnesota,and certifies that all statements made on this application are,true and correc� Applicant• r' �.�' Date: � �� 7 � , �� , ;��r: . � . DATE TIME CITY OF ORONO CALLED IN INSPECTION NQ.�TICE SCHEDULED --��(� —�'�S% PERMIT NO. '-�'.✓�` �'�� COMPLETED ADDRESS ��, �' (/ �'� c_.__ � _�i>�. � c�� - OWNER TELEPHO E NO. �� 'y -�`�� CONTRACTOR � �� S � DESCRIPTION �- ��`- � �� X'��'/'� ly ❑ 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 W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL _ J ❑ DEMO-SITE PTIC INSTALL 2 OWNER►CONTRACTOR TO MEET YOU: YES_NO � COMMENTS: W � 5� 3� �'� pD,�� a � J � f� �l c� 0 � W � Q � 2 W � W � � J � W;%[7 WORKSATISFACTORY:PROCEED �ROJECT COMPIEfE � ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN INSPECTOR WILL REfURN ❑STOP ORDER POSTED.CALL INSPECTOR O CITATION ISSUED O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Ca11 for the next inspection 24 hours in advance. (g52) 249-46�� OwnerlContractor on site:�.G1/l�, 'Q Inspector._�/��— White Copyflnspector's File Canary CopylSite Notice