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HomeMy WebLinkAbout2017-01363 - sewer/water connect CITY OF ORONO * 2017 - 01363 * 2750 KELLEY PARKWAY DATE ISSUED: 10/20/2017 ORONO,MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 3265 SHADYWOOD CIR PIN : 20-117-23-11-0048 LEGAL DESC : SHADYWOOD VILLAS : LOT 7 BLOCK 1 PERMIT TYPE SEWER&WATER PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE CONNECTION NOTE: SEWER AND WATER CONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 WATER CONNECT/DISCONNECT/REPAIR 50.00 FINAL GRADE,INC STATE SURCHARGE SEWER&WATER 1.00 3441 BLUFF DR. JORDAN,MN 55352 TOTAL 101.00 Payment(s) (952)492-5100 Minnesota State License#: BUIL-1442 CREDIT CARD 4416 101.00 OWNER Charles Cudd LLC 15050 23RD AVE N PLYMOUTH,MN 55441- 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 any time for due cause. Applicant Permitee Signature Date Issued By Signature Date 1011912017 10:54 FinalGrade iFAlg952 492 5101 P.0041006 c FOR CITY USE ONLY 110/�I City of Orono Date Reoeived: Permit# P.O.sox 66 2750 Kelley Parkway ❑In-House SAC Determination Form Completed rysial Day,MN 55323 9C 5 9.4600/Fax(952)2494616 Approved By(If Required): CITY OF ORONO—SEWER&WATER/GENERAL PERART ("Note:Some permits may require approval by the Building Official and/or Public Worke Pcpwtment") (ALL P&RMETS- Mav be subtect to further review sad may not be issued when the aooHcatioo is secabmil 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)2494600,24+hour notice required. TYPE OF PERMIT Check All That Ap2W AResidential(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: 1� , Site Address: �[D� weer: Mailing Address: City: r/ n Zip.- Home ip:Nome Phone: Alternate Phone., 4/. �a z LW- eAe Contractor Information: Contrac or:• �! Contact Person: A4// ddress: 5r� State License#: City: Zip: Expiration Date: Phone: 9?A., �9�4.rJG� Alternate Phone: 1011912017 10:54 FinalGrade f X0952 492 5101 P.0051006 DETERMINING PERMIT FEES ❑SAC Charge(2015 Rate=$2,485.00) $ (SAC Charge must accompany all sewer permit applications unless prepaid) (Orono City Staff can determine if applicable) (it not prepaid,a sewer connection permit will not be Issued) Sewer Conn ion/Disconnect/Repair($50.00/Per Stub) $��• 00 Pipe size V inches;material 3_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 Availability Exi2ianation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Department. Reouired Before Water Connection Permit is Issued: 1. Issue Water Meter&Hom 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: $��•�d 2. STATE SURCHARGE $ 1.00 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 separon 1?'rrmit ■ WATER METERS most 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 trade on this application are,true and correct. Applicant: Date: /� ~ DATE TIME V/ CITY OF ORONO CALLED IN INSPECTION FjQTICE SCHEDULED _ �" _30� PERMIT NO. © COMPLETED ADDRESS OWNER / T HONE NO. �✓o� �'J33� CONTRACTOR �1 �( 0 DESCRIPTION W ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING vQj ❑ 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 _yWATER HOOK-UP ❑ FOLLOW-UP W ❑ AS BUILT-SURVEY S v ❑ EWER HOOK-UP ❑ FOUNDATION/REMOVAL ❑ DEMO-SITE SEPTIC INSTALL Z OWNERICONTRACTOR TO MEET YOU:_YES_NO y COMMENTS: J QC O O W C� ca62-GE1� �v�4rZ a7�.c1D r�ip� •U,�t�S Q 7 Z�� 1plD. SEAEno-:J fpm, sow i W z W j W ❑WORK SATISFACTORY:PROCEED ❑PROJECT COMPLETE W ❑CORRECT WORK 3 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY C) BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ^OTO TAKEN INSPECTOR WILL RETURN / E)STOP ORDER POSTED.CALL INSPECTOR [I CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 OwnedContractor on site: Inspector.�1 White Copynnspector's File Canary Copy/Site Notice