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2015-00527 - sewer & water connection
CITY OF ORONO * z 0 1 5 - 0 0 5 2 7 * 2750 KELLEY PARKWAY DATE ISSUED: 05/04/2015 ' ORONO, MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 761 BRIDGEWATER DR PIN : 33-118-23-12-0092 LEGAL DESC : STONEBAY SEVENTH ADDITION : LOT 5 BLOCK 1 PERMIT TYPE : SEWER& WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION NOTE: SAC PAID#2015-00088 04/20/15 APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 WATER CONNECT/DISCONNECT/REPAIR 50.00 BOLLIG&SONS,INC. STATE SURCHARGE SEWER& WATER 5.00 11401 COLTNTY ROAD 3 HOPKINS,MN TOTAL 105.00 (612)938-4433 Payment(s) CREDIT CARD 9081 105.00 OWNER Stonebrook Development LLC 17149 LINCOLN ST NE #600 HAM LAKE, MN 55304- 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 revoke at any time or due cause. 1t,d'../ —� � ' � �'l�'Y�C�c�7 � / �� / lS pplicant Permitee Signature Date Issued B Signature Date � � Fou c�Tv L�sF o�vi.v��.�� p�'-� , �,.,���-��f�I�.-��, Clty Of 01'On0 Date Received: � e' Yennit# E_��-��==-�� ��}JZ""� P.O.Box 66 l � 2750 Kelley Parkway ❑]n-i�ouse SAC Determination Form Completed �ti r f Crystal Bay,MN 5�323 �?�'"�� �`'� � (9�2)249-4600/Fa�(952)249-4616 Approved I3y(If Required): ��� ��.Es:= > __ zG ��. CITY OF ORONO—SEWER & WATER/GENERAL PERMIT �µ� P�' OC's� (*Note:Some p�rmits rnay require approval by the E3uilding O(ficial and/or Public Works Department*) � (A1,L PF.RMITS- Mav be subiect to further revie�v and mav not be issued when the aoplication is received) �(Zp�15� GENERAL INFORMATION l. You may apply for utility permits by maif or in person at the City offices. 2. Mailed in applications are subject to the postabe 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�nust 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 Warks Department(952-249-4600)for utility stub as-b�iilt 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 A 1 ❑ Residential(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: Site Address: ` � � � iC w�'+� �� `v� ' Owner: `�s c�a �� �c� <� Mailing Address: � l l'7 �(uc, C��r , City: U�����- Zip: �-rz,3 Y S c�s-�3 Home Phone: ' Alternate Phone: Contractor Information: Contractor: �`�'(��G � �'''s � Contact Person: �� l��`'�� Address: �l�G � � r��' 3 State License #: � 'J �<�� � � � 3 �� ( — t City: ��'�-' Zip: S� `��Expiration Date: � � � �s�— � � _� � / c2 —���� —s--Q ��7 Phone: �-��' � -�-5 Alternate Phone: v � . � � � 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) (If not prepaid,a sewer connection permit will not be issued) �ewer Con ction/Disconnect/Repair($50.00/Per Stub) $ Pipe size `� inches;material Scl�d 40 air tested; cast iron ater Con ection /Disconnect/Repair(�50.00/Per Stab) $ Pipe size `�� inches;material Schd 40 air tested; copper ❑Water Availability For Future Hook-Up to Water($50.00) $ Water Availabilitv Exnlanation: 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: l. 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 Pennit 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 ineter 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. Applican . 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'� .:;.uar.4�... . , a �� " , t^*'_.�'t'�- ...... __ � z.rl�a� xa.��.l. ,t'"2..*b'..a-.'.a��"�,. j�;; �G3c' �v�4. -�E�d /J%�_ �� �-� I�1� pqTE `1�� TIME � CITY OF ORONO CALLED IN INSPECTION N TICE SCHEDULED �� � PERM�T NO. _ D �Z��OMPLETED ADDRESS �`7 r d R �� OWNER TELEPHONE .� �������3 3 CONTRACTOR ` /� S� S � DESCRIPTION � lt� ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FIN ' 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 ❑ PROGRESS � ❑ INSULATION 0 WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL �WATER HOOK-UP ❑ FOLLOW-UP W ❑ AS BUILT-SURVEY �SE ER HOOK-UP ❑ HARD COVER REMOVAL v ❑ DEMO-SITE ❑ PTIC INSTALL ❑ FOUNDATION/REMOVAL � OWNERICONTRACTORTOMEEfYOU: YES_NO � COMMENTS: �— `_ a / I( ��1�'f�c) �'e �-�-{✓� ` �,;:l,r� �,�� ,j'`r% � � �t.' i '�'�V"� C r_�A.� l� ��'�- �. 2 O � � ) �� 1� i 1� ��� � 1�' 7(C t✓ C'r � C�<'�„i , �C W ) ' �-- Q ..f-(��L� � i :.{�� ;'n,% .;'�5 � � y �� ��/l C � � [ . .�;�%c��'-� � i�f'���c W --�� � � � �,� C�t'' ��; ; i'�f-'' . ����C�/� J W ��NORKSATISFACTORY:PROCEED �OJECT COMPLETE W ❑CORRECT WORK&PROCEED � ❑ ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECWERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑pHOTO TAKEN INSPECTOR WILL REfURN ❑ STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952� 249-4600 OwnerlContractor on site: l3 C f��� � s �:L�> Inspector._�� � �/ ' White Copyllnspector's File Canary CopylSite Notice