HomeMy WebLinkAbout2016 - 00920 - sewer disconnect CITY OF ORONO
III I III 1II.. III 11111111 II
2 750 KELLEY PARKWAY * 2 0 1 6 - 0 0 9
DATE ISSUED: 08/04/22 011
6
ORONO,MN 55356-
( T2-l9-4600 FAX: (952)249-4616
ADDRESS : 2120 \\'.` ' ` 1..\ HIND LVD W
PIN : 3,1-IIS _ nnr)I
LEGAL DESC : UNPLA I ! : D3,1118 23
: LO•IT WO 11 LOCK 000
PERMIT TYPE : S1;vy'I:I.
PROPERTY TYPE : RLS I I)N T I A I,
CONSTRUCTION TYPE : DISCONN!V. 'ION
APPLICA`"U SEWER CONNECT/DISCONNECT/REPAIR 50.00
STATE SURCHARGE SEWER&WATER 1.00
AMERICAN MECHANICAL CO, C , MAIL-IN FEE 2.00
7120 71ST AVE.N.
PO BOX 205 TOTAL 53.00
LORETTO,MN 55357- Payment(s)
(612)750-0278 CREDIT CARD 6203 53.00
OWNER
ERICKSON,BRAD
2486 BOBOLINK RD
MEDINA,MN 55356-
AGREEMENT AND SWO►."
The work for which this permit is issued shall according to
the approved plans and specifications,applicable Cilyvals,and the
State Building Code. This permit is for only the st om k r..crihal and does
not grant permission for additional or related ...... . ......cc separate
permits. All provisions of laws and ordin. 'res:'m ype or work
shall be compied with whether or not spec't ie l' ,.: .. a,, , t
expire and become null and void if construct imsi;em' rf
commenced within 180 days of the date of i«,:a:,ce.o•. ,,tioo is
suspended for a period of 180 days at any. care <col,nnenced.
The applicant is responsible for assuring ah.. ......,
requested in conformance with the State I t• .• • 1 c ;:,,it may be
revoked at any time for due cause.
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Applicant Permitee Signature Issued By Signature Date
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'Box 66 • ;ed t 1
Kelley Parkway a } a Hou :.+ ,:,
1 : 5323 r .ar .,
.rove t,': -
•a i3` p . rpt+� �� ATER/ •«�•fa ,
t:uildin Official and/or} ,h. .
Vote, ,.,,,..4i40;;;?;,... 8 a°,4 .
„to,- LB . ,-:,B ai a d ma not be issued whru t1l"+ `
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i'apphcaa ai4•'4';:71:t4';:54:ii,..naritdt:ihtne,gCli
ee S114 V• nI;.: '. . i' lnl vill
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rm Fare not valid un a} +a�, ► 't' •''''171.7.:11r,-.1.1
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5 ozk must not be unl a ,iv" .t ate•p +B 'e job',oc. „ - "
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4 connecttoax;; .11,l. a� ams a�s.aAi a S. .:cforconl. �� a d ..
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a ,royal of the Public �`i Sa'4a BB� � aa.t` ,I,fa a permit does ni t grant t,1., ;,proval 1
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7 ' :must be$ b E6 a' i„88 ,; j f t 1 t a-Y .' 'rements. 8 t` '
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Contractor Informat - ` rt `' a
Contractor: i#K1 An .ttliif' '.'" ''-‘' fr®t'✓ '� 1 hely t1 n Gf/ r '
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e' Address: X.i/ /� m'i� ',.:.- -,*--.77r;:"
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ity: LD Zip .��-.. x�.1�ix.,pl�tt�P��,�a� ,x � �' � ;,�• � �f a � '
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' ■ SAC Charge(2016Rate $2,485.(10)
(SAC Charge must accompany all sewe, pL,i v,i, : ,
(Orono City Staff can determine if applicahl, t.
(If not prepaid,a sewer connection pcc.o.. ,.
-Al Sewer Conntfc�ion I 1 iscQnrnect , epair(,,;;,:. A
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Pipe s4 Mc' �. a tii sun,.
s s Ad°
❑". titer Connection I T)tsc�` tic ,,Repair{:::.i., , _ F
Pipe size inches; materia Scud';t, ; ,. (i. ,,
El Water Availability For Future Hook-Up i.r ;
Water Availability Explanation:
Contractor installed line to inside of house I, ,;).
AltiThis line will be inspected by the Public Work, i, , ..
Required Before Water Connection Permit i ,'' `
I. Issue Water Meter& Hon!,Permit kit,:-'-1
2. Any Additional ConneFees I':: ;. f :) ',«
c te:,2: #D.
}lr4s` ' Connection Permit; F
,)1ect Permit F,,, „ 1.sue Water(.,,;,,.. t y,i
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ii.-, !r
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i SUBTOTAL of Permit Reque .tt 7/�¢
2. STATE SURCHARG -', ,t: 1.00 . ;. 4t .w
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POSTAGE R"N i�R i* 6litv,, ! ad-In Al I „ . :) 2.00 i�e'
,:4. T$ t `L PERMI 4; ' v;, a i` ti . ,
4,1.3 ,. ,,I,",� , ,, 1.t ON \VA'CEIZ ME'1 l,(ZS4. J r
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t'v'•:' ' -v-E E'STmust 'e`picked up and paid for at Orono City hilt,thrsc.:,, on a separa 1; ��.�
.y': WATE,, ,4, TERS must be set and sealed by Orono Water Departoieoot t""52) 249-4600, >up0;, �)°
° corn a I . ...oi meter installation
ie undersigned hereby a.$ to the City of ono for issuance of a Utility Permit,agrees' t.
II work in strict .• . . �,< ordinances of the City aid the regulations of the Stag+J;
t ani certif s sta o' nts :de ott this application are,true and correct ', f `:.°r a
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DAT 7� TIM
CITY OF ORONO CALLED IN
INSPECTIONMV,IC /y j SCHEDULED /O
PERMIT NO. /� (JTT' Ake
MPLETED /
ADDRESS r71/ 3O `' / -Q� i/ i
OWNER 4PHONE
CONTRACTOR /� ant
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>2 DESCRIPTION GI'SCo+;—
tai,.. ❑ FOOTING 0 DEMO-FINAL 0 SEPTIC FINAL
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❑ POURED WALL 0 PLUMBING RI 0 EXCAV/GRADING/FILLING
14 0 FOUNDATION WATERPROOF 0 PLUMBING FINAL 0 TREE REMOVAL
C
Z ❑ RADON SLAB 0 MECHANICAL RI 0 SITE INSPECTION
Q 0 FRAMING 0 MECHANICAL FINAL 0 RATED WALLS
is ❑ INSULATION 0 WOOD BURNER/FIREPLACE 0 COMPLAINT
Q ❑ FINAL 0 WATER HOOK-UP 0 FOLLOW-UP
W ❑ AS BUILT-SURVEY 0 SEWER HOOK-UP 0 FOUNDATION/REMOVAL
✓ ❑ DEMO-SITE ElSEPTIC INSTALL
Q OWNERICONTRACTOR TO MEET YOU: YES_NO
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a COMMENTS: �-) �I pt/ Ci ppod " •vP/ese
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LRK SATISFACTORY:PROCEED/7Zi(;t,,N7/J)7 OJECT COMPLETE
W 0 CORRECT WORK&PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
CO 0 CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
o CORRECT UNSAFE CONDITION WITHIN HOURS. ❑PHOTO TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Can for the next inspect24 hours in advance. (952) 249-4600
Owner/Contractor on site:
Inspector. �C_C' `/
White Copy/Inspector's File Canary CopyISlte Notice