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HomeMy WebLinkAbout2015-00528 - sac connect CITY OF ORONO * Z 0 1 5 - 0 0 5 2 8 * 2750 KELLEY PARKWAY DATE ISSUED: OS/04/2015 . ORONO, MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 763 BRIDGEWATER DR PIN : 33-118-23-12-0091 LEGAL DESC : STONEBAY SEVENTH ADDITION : LOT 4 BLOCK 1 PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION NOTE: SAC PAID#2015-00094 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 COCJNTY ROAD 3 HOPKINS,MN TOTAL 105.00 (612)938-4433 Payment(s) CREDIT CARD 9081 105.00 OWNER Stonebrook Development LLC 6117 BLUE CIRCLE DRIVE MINNETONKA,MN 55343- AGREEMENT AIVD 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 aze requested in conformance with the State Building Code.This permit may be revoked t any time for due cause. `1« _ ,�� � (r�'VL���7 � � � � � plicant Permitee Signature Date [ssued By Signature Date � �ou crTv t�sF o�vi,v . ��t��/��� City of OI'ono Date Received: Permit# P.O.F3ox 66 �� 2750 Kellcy Parkway ❑In-House SAC Detennination Form Completed r F Crystal Bay,MN 5�323 ",y��%�''� �u`;� (9�2)249-4600/Fax(9521 2�9-�361G Approved t3y(If Required): ;.��_ �;� CITY OF ORONO-SEWER & WATER/GENEKAL PERMIT ; �1� 15��'�� ( Note.Some p�rmits may rcquire approval by the Building Official and/or Public Works Department ) �� �� � ����( (AI.L PERMITS- Mav be subiect to f'urther review and mav not be issued when the apolication is received) GENERAL INFORMATION 1. You may apply for utility permits by mail or in person at the City ofCces. 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 Deparnnent(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without espress 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: �� I� r �r �-��� � � i�v� Owner: ��3G�C�� �� c�`�'''— Mailing Address: ��� � �(�'G �f � , City: �✓1��=�- Zip: Home Phone: cI.SJZ '��'� �-�`�-3 Alternate Phone: Contractor Information: Contractor: ��al�i ���� Contact Person: i�u^ ��-"�— Address: � �l � C� --� �� � � �'� � � � � State License #: City: O���S Zip: `'���Expiration Date: � � -� 3 � � �� � Phone: I_.5������`���`�f Alternate Phone: CC L "��I�-��'� �� / . DETERMINING PERMIT FEES ` ❑ SAC Charge(2015 Rate=$2,485.00) $ (SAC 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) �ewer Connection/Disconnect/Repair($50.00/Per Stub) $ Pipe size U ` inches;material � Schd 40 air tested; cast iron ���k�_ �Water Connection/Disconnect/Repair($50.00/Per Stub) $ Pipe size l �� inches;material o S�_Schd 40 air tested; copper l ❑Water Availability For Future Hook-Up to Water($50.00) $ Water Availabilitv Exalanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Department. Required Before Water Connecrion Permit is Issued: 1. Issue Water Meter&Horn Permit 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Connection Permit: l. Collect Permit Fee& Issue Water Connection Permit l. SUBTOTAL of Pennit Requested: $ 2. STATE SURCHARGE $ 5.00 3. POSTAGE& HANDLING(Only on Mail-ln 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. - S Applica . Date: � _ —` � � ?�'� � rq.�;�,.�rn�„�ara ��'_.�"�, � 1 f �.,�a' �� , . w�u�' 4�, ��.��g� ' � , 3 •;�2 �� i'v r�- .:�"- � �. � , , , � , x f� ,� _ �,` ���, �,.: '�"*�v Y�t � y �-I .��' � �� � 4 �� . . 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'���� ��: _ �� .f � ,Alx.�a < � �y � '<M�..� ` � t P 1�!�KI I+�� . 11/I ,� �v��'�� 2�� • - �ATE��J�� �/�� �CITY OF ORONO CALLED IN INSPE�TION N TICE �CHEDULED PER�a�NO. �� "�J COMPLETED ADDRESS "� ' �� OWNER TELEP ONE NO. `� — �3� CONTRACTOR I I C' � S �; DESCRIPTION �E%e-�-�h' � 1C1� ���� W ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING y ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ PROGRESS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT J ❑ FINAL �WATER HOOK-UP ❑ FOLLOW-UP _ ❑ AS BUILT-SURVEY r�SEWER HOOK-UP ❑ HARD COVER REMOVAL J ❑ DEMO-SITE ❑ S P IC INSTALL ❑ FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU: YES_NO � COMMENTS: �/ �� SC✓� yZ' � t�C .SGLt,%'P..�' a v> ~ ' � /"�9 �'�v' t�-r a �: S ��s' o � ��ST .— / ,� � C' �. � 0 � W Q I �r f��`,r� ��/.�3��� � G��.�"�ir s f'/'v� �G / zc:.:,1i 7�► ��i"����- �ic,'.��. W � W � J y� W WORKSATISFACTORY:PROCEED /d PROJECTCOMPLEfE � ❑ ORRECT WORK 8 PROCEED . ❑ ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pH0T0 TAKEN INSPECTOR WILL REfURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Cail forthe next inspection 2a hours in advance. (g52) 249-4600 OwnerfConVactor on site: ����� ��>"v_� Inspector. � ���� White Copyllnspector's Ffle Canary CopylSite Notice