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Home My WebLink About2015-01494 - sewer disconnection CITY OF ORONO * Z p� 1 5 - 0 1 4 9 4 * �� 2750 KELLEY PARKWAY DATE ISSUED: 1U20/2015 ORONO, MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 1380 BRIAR ST PIN : 10-117-23-31-0053 LEGAL DESC : MARKVILLE : LOT 000 BLOCK 002 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTTON TYPE : DISCONNECTION NOTE: SEWER DISCONNECTION APPLICAIVT SEWER CONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER& WATER 1.00 OUVERSON SEWER&WATER TOTAL 51.00 P O BOX 247 LORETTO, MN 55357- Payment(s) Minnesota State License#: SW-MR86668 CREDIT CARD 9781 51.00 OWNER ZITZLOFF,JEFFREY&BRENDA 1380 BRIAR ST WAYZATA,MN 55391- 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 wi[h 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 c se. �' �� ! ��' � — �� ^ ll l ��l !� Applicant Permitee StgnaturL✓' Date Issued ignature Date - FOR crrY usE o:vt.r -,��Z�� City of Orono Date Received: Permit# P.O.Box 66 �� 2750 Ketley Pazkway ❑In-House SAC Deterniinauou Form Completed i , �- Crystal Bay,MN 55323 �'f,`,�_�t�'� ,•�� (952)249-4600/Fax(952)249-�i616 Approved By(if Required')� � CiTY OF ORONO— SEWER&WATER/GENERAL PERMIT (*Note:Some pennits may require approval by the Building Official anti/or Public Works llepartment*) (ALL PERMITS- Mav be subtect to further review and mav not be issued when the apulication is received) GENERAL INFORMATION 1. You may apply for utility pern�its by mail or in person at the City of�ices. 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 co�ltractors only. 6. Contact the Public Works Department(452-249-460O)for utility stub as-built loeations. DO NOT EXCAVATE IN ANI'STREET AND DO NOT TAP ANY MAIIV 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)249-4600,2A+hour notice required. TYPE OF PERMIT (Check A111"hat Apply) �Residential(May Require Approval) ❑Commercial(Approval Required) ❑ New Connection ❑Additional Connection ❑Re-Connection ❑Repairs �isconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site / Owner Information: Site Address: � } �� ►y��' � � � ` � r 1 �i�;E�i ��'�r �s'��LLi�'l.. Owner: ,� j t Z, �,� {— Mailin�;Address: �,� � L Clly: tJ� ��.�� Zl[�: � ��( � Home Phone: Alternate Phone: Contractor Information: �� Contractor: ��"L�+'��'� ��-�r l �'• �C�ontactPerson: ,�'� � ��'�J9` Address: �� ''` Z y � State License#: �y,� ��`� City: ��r"� ��° Zip: s��xpiration Date: j � � �' Phone: � �2 �f � �� Alternate Phone: DETERMINING PERMIT FEES ❑SAC Charge(2015 Rate=$2,485.00) $ (5AC Charge must accompany all sewer permit applications unless prepaid) (Orono Ciry Staff can determine if applicable) (If not prepaid,a sewer connection permit will not be issued) �Sewer Connection isconnec /Repair($50.00/Per Stub) $ �U � Pipe size�inc i , enal �c- 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 Availabilitv Explanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Warks Department. Required Sefore Water Cotuiection Pennit 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 S� __° 1. SUBTOTAL of Permit Reyuested: $ 2. STATE SURCHARGE $ 1.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMiT FEE(Add Lines 1-3 Above) $ 7 � ' ADDITIONAL INFORMATION-WATER METERS • WATER ME'CERS must be picked up and paid for at Orono City Hall,these are on a separate pernut. ■ WATF,R MFTERS must be set and sealed by Orono Water Department (952) 249-4600, upon completion of ineter instaltation. 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 mad�on this application are,true and correct. �-- I o A licant: � Date: � 2 �r PP V� DATE TIME CITY OF ORONO CALLED IN I -� INSPECTION NO ICE �CHEDULED /`o�Gs o4.1?il• PERMIT NO. � � 9 COI�4PLETED ADDRESS � 3 S�, V`1-Q.Ir ��-�" OWNER TELEPHONE N CONTRACTOR � �I��I^�� `Y � DESCRIPTION VZ%�-✓� �-5�'�9��-� ly ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING Q ❑ 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 � ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL v ❑ DEMO-SITE ❑ SEPTIC INSTALL Z OWNERICONTRACTOR TO MEET YOU:_YES_NO O � 'I � COMMENTS: ��_�( � Cr��.� W C � � o �I�G/� � W � Q � 2 W � W � � J , JJ��WORKSATISFACTORY:PROCEED �PROJECT COMPLEfE � � ❑�RRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN INSPECTOR WILL REfURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Ca11 forthe next inspection 24 hours in advance. (952� 249-4600 OwnerfContractor on site: Inspector: �il�� White Copyllnspector's File Canary CopylSke Notice