HomeMy WebLinkAbout2012-00304 - sewer/water connect y CITY OF ORONO
* 2012 - 00304 *
2750 KELLEY PARKWAY DATE ISSUED: 04/19/2012
ORONO,MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS 3645 TOGO RD
PIN 17-117-23-31-0034
LEGAL DESC TOWNSITE OF LANGDON PARK
LOT 006 BLOCK 010
PERMIT TYPE SEWER&WATER
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE CONNECTION
NOTE: WATER&SEWER CONNECTION
SEWER PIPE SIZE-4" PVC
WATER PIPE SIZE- V PVC
APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00
GROTH SEWER&WATER WATER CONNECT/DISCONNECT/REPAIR 50.00
775 TOWER DRIVE
HAMEL,MN 55340- STATE SURCHARGE SEWER&WATER 5.00
(763)478-6712 TOTAL 105.00
Minnesota State License#:058606-PM
OWNER
ZHUK,ELENA
3645 TOGO RD
WAYZATA,MN 55391-
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 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 anime for due cause.
� / fl- / /2 '�4, � / '
' -
Ap t tee S nature Date Is By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
4 _ i
C uSE ONLY
¢0 City of Orono Date'Received: Permit# -, a30
O O P.O.Box 66
2750 Kelley Parkway 0 hi=House SAC 'nation Form Completed
w' Crystal Bay,MN 55323
'dao 4 (952)249-4600 Approved By(If Requited):
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CITY OF ORONO—SEWER& WATER/GENERAL PERMIT
(*Note:Some permits may require approval by the Building Official and/or Public Works Department*)
(ALL PERMITS- May be subject to further review and may not be issued when the anolication is received)
GENERAL INFORMATTON
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 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 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)2494600,24+hour notice required.
TYPE.OF PERMIT,
Check All That Apply)
❑Residential(May Require Approval) ❑Commercial(Approval Required)
❑ New Connection ❑Additional Connection 4Re-Connection [:1 Repairs ❑Disconnect
El Water Availability Connection For Future Hook-Up to Water
Job Site/Owner information:
Site Address: /
Owner::,� J,'9 ���1� Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor:'�-7XOV4 v Contact Person:
Address: 77> P� State License#: d
City: Zip3 4 4xpiration Date:
Phone-76? 7 '2 � b �7/ `- Alternate Phone: ������ ��
� M
❑ SAC Charge(2012 Rate=$2,365.00) $
(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 Connection/Disconnect/Repair($50.00/Per Stub) $
Pipe size L inches;material_ 1b_Schd 40 air tested; cast iron
FVZ_
Water Connection/Disconnect/ air($50.00/Per Stub) $
Pipe size (" inches;material Schd 40 air tested; copper
❑Water Availability For Future Hook-Up to Water($50.00) $
Water Availability Ezulanation:
Contractor installed line to inside of house for future hook-up.
This line will be inspected by the Public Works Department.
Required Before Water Connection 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 $ 5.00
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
ADDITIONAL INFORMATI{JN 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) 2494600, upon
completion of meter 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 stateme is made on this application are,true and correct.
Applicant: Date: JT
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CIT',iOF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED Z
PERMIT NO._n"RO 't20 coMP ED
ADDRESS G �7
OWNER TE ONE N0���1
CONTRACTOR !w
DESCRIPTION
t4 ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAWGRADING/FILLING
Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WERANDS
h ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL
❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
❑ RADON SLAB A WATER HOOK-UP ❑ PROGRESS
❑ FINAL `SEWER HOOK-UP ❑ COMPLAINT
v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
_ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
OWNERICONTRACTOR TO MEET YOU:_YES_NO
OMMENTS:
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Wl WORK SATISFACTORY:PROCEED ❑ PROJ OMPLEfE
W �❑'CORRECT WORK&PROCEED ((�I SUE CERTIFIC CCUPANCY
Q ElCORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTOTAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR El CITATION ISSUED
❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-4600
Owner/Contractor on site: 43���
Inspector. S
White CopylInspector's File Canary Copy/Site Notice