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Home My WebLink About2014 - 00475 - sewer connect CITY OF ORONO HI 1 III1I II 1I 1111 II 1111 II 2750 KELLEY PARKWAY DATE ISSUED: 05/19/2014 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 364 WESTLAKE ST PIN : 05-117-23-23-0043 LEGAL DESC : HILLSIDE PARK : LOT 000 BLOCK 001 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER&WATER 5.00 LEADENS EXCAVATING 21520 OAKDALE DR S.A.C. 0.00 ROGERS, MN 55374- TOTAL 55.00 (612)490-4993 Payment(s) Minnesota State License#: GENR-PB643191 CREDIT CARD 2654 55.00 OWNER Identisys,Inc. SHIELDS TRUSTEES,JANELLE K&MICHAEL R 7630 COMMERCE WAY EDEN PRAIRIE,MN 55344- 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 goveming 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 se. ' Applicant Permitee Signature Date Issued By iinature Date e ‘ '5 FOR CITY USE ONLY ..y--O/v City of Orono Date Received: Permit# P.O.Box 66 , \ 2750 Kelley Parkway 0 In-House SAC Determination Form Completed Crystal Bay,MN 55323 "‘ ,,' (952)249-4600/Fax(952)249-4616 Approved By(If Required): 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) ❑Resi ntial(May Require Approval) ❑Co ercial(Approval Required) ew Connection ❑Additional Connection e-Connection ❑Repairs E Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address: 3 -6'4 LV L ,4e__ S \ Owner: 1 t av ` `3 Mailing Address: City: Zip: Home Phone: Alternate Phone: Contractor Information: Contractor: L etI, 4¢-Et,-U ,Contact Person: T-e- Address: 71S?C' i'L_- tate License#: l 3 \c't 1 City: • - ip:expiration Date: /Z/306— Phone: Z/3I '6 SPhone: / (Z-(/9 0'1-9,q3 Alternate Phone: t DETERMINING PERMIT FEES ❑SAC Charge(2014 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 0 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 $ 5.00 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 statements made on this application are,true and correct. Applicant: --VA--Q Date: It i l� DAT CITY OF ORONO CALLED IN TIMEs. `� INSPECTION NOTIPE `/ .f SCHEDULED - /T zf� PERMIT NO. o7Dl4 GO T 1 COMPLETED ADDRESS `f WestCa. SLS OWNER TELEPHONE NO. CONTRACTOR LO.ode-A-J-" DESCRIPTION SeW2-4-- Cent C 15\---) 4.1 El FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS " ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS El FINALSEWER HOOK-UP 0 COMPLAINT ❑ DEMO-SITE / ❑ SEPTIC MAINT. 0 FOLLOW-UP i ❑ DEMO-FINAL ❑ SEPTIC INSTALL 0 HARD COVER REMOVAL ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL Q OWNER/CONTRACTOR TO MEET YOU:_/YES_NO �.sj COMMENTS: qti 5'c /p-e 1/v tcc Lct _ )Jlr cc cc cc 12 W z W cc W ii •RK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE ❑CORRECT WORK&PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY CI ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY 0 BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑PHOTO TAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR 0 INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. 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