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Home My WebLink About2010-00229 - sewer/water connect CITY OF ORONO PERMIT NO.: 2010-00229 1 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUED: 04/14/2010 952 249-4600 FAX: 952 249-4616 ADDRESS 4655 TONKAVIEW LA PIN 07-117-23-32-0064 LEGAL DESC N/A LOT 000 BLOCK 000 PERMIT TYPE SEWER&WATER PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE CONNECTION NOTE: SAC GRANDFATHERED IN-RECLAIM DEMO CREDIT APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 BORN WELL DRILLING CO. 16550 BASELINE AVE. STATE SURCHARGE SEWER&WATER 0.50 SHAKOPEE,MN 55379 TOTAL 50.50 (952)445-4809 Minnesota State License#: 1043 OWNER LICURSI,ANGELO&RACHEL 17601 70TH PLACE N MAPLE GROVE,MN 55311- 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 or due cause. 911y"'110 pplicant Permitee Signature Date Issued ignature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOV FOR CITY USE ONLY O City of Orono Date Received: Permit# P.O.Box 66 0\" 2750 Kelley Parkway ❑In-House SAC Determination Form Completed Crystal Bay,MN 55323 (952)249-4600 Approved By(If Required): �bKos 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 auulication is received) GENERAL INFORMATION 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)249-4600,24+hour notice required. TYPE OF PERMIT Check All That Apply) ❑� Residential(May Require Approval) E]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: 4655 Tonka View Lane Owner: Angelo&Rachel Licursi Mailing Address: 17601 70th Place N City: Maple Grove Zip: 55311 Home Phone: Alternate Phone: Contractor Information: Contractor: Bohn Well Drilling Co Contact Person: Charlie Bohn 18190 Dairy Lane, Ste 101 Address: State License#: City: Jordan Zip:55352 Expiration Date: Phone: (952)445-4809 Alternate Phone: (612)919-1542 I DETERMINING PERMIT FEES ❑SAC Charge(2010 Rate=$2,100.00) $ (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) $ '0, 00 Pipe size inches;material Schd 40 air tested; cast iron Water Connection/Disconnect/Repair($50.00/Per Stub) $ - C7 Pipe size inches;material Schd 40 air tested; copper ❑Water Availability For Future Hook-Up to Water($50.00) $ Water Availability Explanation: 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: $ /00. 00 2. STATE SURCHARGE $ .50 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ -g-66' 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ 160 .50 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) 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 statements made on this application are,true and correct. Applicant: X&� Date: 04/14/10 Reset Form I"FC �i�Fv Sewer Water Hookup Form MAY q ?0 Date: Inspection Time: ANO Job Number: p /oU Builder/Homeowner Name: Site Addresss c.((o 5�7 vn ka ve�'uV L,w Footages Pipe Size Outside Waterline Pipe Bedding Materials: Inside Waterline Tons 3/4"Clear Rock Sot' 4"Pipe Footages Tons Sand Condition of Trench: Quantity Quantity Size 4" Sch 40 PVC 45'Ell 1"Flare to Flare Union j 4 Sch 40 PVC 160 Ell 1"Flare to Thread 4" Sch 40 PVC 90"Ell 1"Ball Valve 4"Sch 40-35 Adaptor Curb Stop Box (Size: 4"Sch 40 Cap Other U W Other Other Other As-built Dlawam p.,rostd WeA Ton g y,ew Mai h, n� Bohn Well DriNmq CD Paperwork Completed By �/ ,4—(,67 — _C I TE TIME CITY OF ORONO CALLED IN INSPECTION NOTICE SCHEDULED PERMIT NO. -a/y/U- a;k--z7 COMPLETED ADDRESS �` SS Vie OWNER CONTRACTOR DESCRIPTION ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI El /WETLANDS h ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS ❑ FINAL KVISEWER HOOK-UP El COMPLAINT 1:1 DEMO-SITE /❑ SEPTIC MAINT ❑ FOLLOW-UP i ❑ DEMO-FINAL ❑ SEPT C INSTALL ElHARD COVER REMOVAL v 11PLUMBING RI ❑ SEPC FINAL ❑ FOUNDATIOWREMOVAL OWNERICONTRACTOR TO MEET YOU:—YES—NO cam., COMMENTS: cc W Q. 0 i ( � �S !) — cc LL ,44-S n W QC Q z W W cc d W K SATISFACTORY:PROCEED ❑ PROJECT COMPLETE ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT 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 sit Inspector. White Copyllnspectoes File Canary Copy/Site Notice