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Home My WebLink About2017-00651 - sewer disconnect IMMUSERM CITY OF ORONO * 2 0 1 7 — PJ 0 6 5 1 2750 KELLEY PARKWAY DATE ISSUED: 06/15/2017 ORONO,MN 55356- (952)249-4600 FAX: (952) 2494616 ADDRESS 780 TONKAWA RD PIN 05-117-23-34-0010 LEGAL DESC PARTENS POINT 1ST DIV LOT 015 BLOCK 000 PERMIT TYPE SEWER PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE DISCONNECTION NOTE: DISCONNECT ONLY APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 BOLLIG&SONS,INC. STATE SURCHARGE SEWER&WATER 1.00 TOTAL 51.00 11401 COUNTY ROAD 3 HOPKINS,MN 55343- Payment(s) (952)938-4133 CREDIT CARD 9081 51.00 OWNER MENZEL,KEITH 780 TONKAWA RD 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 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 respon le for assuring all r red inspections are requested in conforwipte the State B mg Code.This permit may be revoked at any ti '�r due cause. Applicant Permitee Signature Date Issued By Signature Date SE ONLY.�7� �� bd �0N��,, City Of Orono Date Received:FO'�rmit# P.O.Box 66 j 2750 Kelley Parkway ❑In-House SAC Determination Form Completed y 1 Crystal Bay,MN 55323 � ��4 j (952)249-4600/Fax(952)249-4616 Approved By(If Required): r%" 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 application 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) ❑Commercial(Approval Required) ❑New Connection ❑Additional Connection ❑Re-Connection ❑Repairs kIDisconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address: Owner: 1{�� /"Ln.� �e I Mailing Address: City: Zip: Home Phone: 2' S 1 0 c7 Alternate Phone: Contractor Information: I Contractor: 6 Contact Person: �-- Address: II`iy 1 C G Q 3 State License#: p X19 q 1.3 City: I� C7 `^S Zip:�N3 Expiration Date: 3 ) - I Phone: S 2 `7 3 `/15 3 Alternate Phone: 12 y$ � 2`1 �., DETWOM ❑SAC Charge(2016 Rate=$2,485.00) $ (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 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 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: $ 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 separate permit. ■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, 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 s made on this application are,true and correct. Applicant: Date: b` + r ` DATE E CITY OF ORONO CALLED IN INSPECTION NOTICE � SCHEDULED PERMIT NO._ COMPLETED ADDRESS 'J `T k ot OWNER TELEPHONE NO. J 2 4c�� CONTRACTOR D ict <1S DESCRIPTION ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING C ❑ 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 v ❑ DEMO-SITE ❑ EPTIC INSTALL Z O INERICONTRACTOR TO MEET YOU: YES_NO y COMMENTS: Q / ✓.��1iV e t Al I�3 o Ar r.- WORK SATISFACTORY`.PROCEED 0("WECT COMPLETE W ❑CORRECT WORK a PROCEED Cl ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. O PHOTO TAKEN INSPECTOR WILL RETURN O STOP ORDER POSTED.CALL INSPECTOR 0 CMATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24lijurs In advance. (952) 249-4600 OwnimtContrector on site: Inspector: 7 C White Copyllnapectora FIN Canary Copyffi to Notice