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HomeMy WebLinkAbout2014-00333 (sewer & water connection) * "' CITY OF ORONO * 2 0 1 4 — 0 0 3 3 3 * 2750 KELLEY PARKWAY DATE ISSUEll: 04/18/2014 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2627 CASCADE LA PIN : 33-118-23-I1-0115 LEGAL DESC : STONEBAY FIFTH ADDITION : LOT 005 BLOCK 001 PERMIT TYPE : SEWER& WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCT[ON TYPE : CONNECTION NOTf;: WATER& SEW�R CONNF,CTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 WATER CONNECT/DISCONNECT/REPAIR 50.00 T& J CONCRETE STATE SURCHARGE SEWER& WATER 5.00 9100 BALTIMORE STREET NE BLAINE, MN 55449- TOTAL 105.00 (763)413-0988 Payment(s) Minnesota State License#: SW-646112 CHECK 12865 105.00 OWNER BU[LDERS LLC, STONEBAY 14870 BROCKTON LANE DAYTON, MN 55327- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be periormed according to the approved plans and specifications,applicable City approvals,and the State[3uilding Code. '�his perniit 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 specitied herein.This permit will expire and become null and void if construction authorized is not commenced within 180 days ofthe date of issuance,or if constr��ction 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 cunformance with the State E3uilding Code.This permit may be revoked at anv time for due cause. � ����`�� , �,/ � Applicant Permitee Signature Date � Issu By Signature Date � � i � FOR CITY USE QNLY � ����/� Cit;V of Ol'ono Date Recei��ed: Pemitt# P.O.Box 66 V\� �750 Kelley Puk�tiay ❑In-House SAC Detercnwat�un Form Completed �` E ; . Crystat Bay.VfN 553?3 �; •r'\ (9��)?49-4600 Fax(952)349-�616 Ap�xoved By(If Requveci): ''`�'' CITY OF ORONO—SEWER& WATER/GENERAL PERMIT (`Note:Sonu permits inay requue appro�•al Uy @ie Building Offic�al aiul`or Publ�c Works Depa�trne�u*) (ALL PERAIITS- �Iav be subicct to further reriew and mat�aot be issued tvben the aaplicatioo is recei�•ed) GENERAL INFORMATION ' 1. You may apply for utility pemiits by mail or in person at the City offices. 2. Mailed 'ui applications�re subject to d�e postage and handling fee shown betow. Pennit cards will be sent by rehun mail within 2 business days. 3. Pei•inits are uot valid until you i•eceive x permit cArd. 4. Work must not begui unless die pennit card is a�-ailable on the job site. S. Utility comiection pennits may be issued to licensed contractors only. 6. Contact the Public Works Department(952-249-4600)for utility shib as-built locations. DO NOT EXCAVATE IN AI�'Y STREET A.\'D DO 1`TOT T�IP A1�Y MAIN wittiout express approvai of the Public Vb'ockc Depnirtment. Issuance of a permit does not grant this appro��al. 7. All work nnist be done in accordance with State Code requirements. 8. All work must be uispected before it is covered. Call(952)249-4600,24+I�our notice required. TYPE OF PERMIT Check All That A 1 [�Residential(May Reqixire Approval) ❑Commercial(Approval Req�iired) �New Coruiection ❑Additional Coruiection ❑Re-Cotmection ❑Repau•s ❑Discoiuiect ❑ Water A�-ailaUility Conuection For Furiire Hook-Up to Water Job Site/Owxier Information: Site Address: o�(oa7 _ � �Q{�Lk_� Owner:�OYtQ_ �_ � `d�Q1'S Mailing Address: City: Zip: Home Phoue: Alteni�te Phone: Contractor Iufonnatiou: Contractor: 1 c�-S Ci.0Y1C,Y'� � Contact Person: 11�� �'�1.. �l�'�'C�6Y� aa�� �- Address: q106 t30.(,'Etrn�,�t I-�� State License#: City: �_IL£. Zip:C'�� Expuation Date: Phone: �Io3��t���-b�1�� Alteinate P�ione: ��a-��� —2`�Q� s , r DETER1vIINI1�TG PERMIT FEES ❑SAC C6arge(2014 Rate=$2,485.00) S (SAC Charge must accompany alI sewer pennit applications untess prepaid) (Orono City Staff can detennine if applicable) (If not pcepaid,a sQwer conne.ction permit h�ill not be issued) �Sewer Connection/Disconaect/Repa'r(550.00/Per Stab) S Pipe size�inches;mate�riaNl��chd 40 air tested; cast iron `C�'` �WAter Conn tion/Discounect/Repai�•,($50.00/Per Stub) $ Pipe size � uiches;material�V�Schd 40 au•tested: copper ,�r,�.� . ❑Watec Availxbility�'or Future Hook-Up to Water(S50.00) $ � wA�PI'AYAtIAUII�fV EXP�AOA11011: � j Conh•actor installed line to inside of house for fuh►re hook-up. This line��ill be inspected by the Public Works Department. Requu�ed Befoce Water Connectio�i Peiniit is Issued: 1. Issue Water Meter&Horn Perntit 2. Any Additioiial Cocu�ectioii Fees Paid(If Applicable) � Issue Water Connection Perniit: 1. Coliect Perrnit Fee&Issue Water Connection Pennit 1. SCBTOTAL of Pennit Requested: $ 2. STATE SURCHARGE $ 5.00 3. POSTAGE&HANDLING(Only on Mail-Iii Applications) $ 2.00 4. TOTAL PERMIT FEE(Add L'nies 1-3 Abo�e) S � ADDITIONAL INF�RMATION—WATER METERS ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate uennit. • WATER METERS �nust be set and seAled by Oi�ouo Water Depxitment (952) 249-4600, upou completiou of inetei'�llStRIIA[�011. The undersigned hrreby applics to thc City vf Orono for issuance of a ti tility Pennit, agrees to do all work in strict accordance with the ordinances of tl�e City and tl�e regulations of the State of Miimesota, azid certifies that all st�teuieuts rnade on tlus application are,hue uid conect. . �". Applicant: � Date: <{-17-�1� � , -�.: � A , , '� �� �j ; � �:r � '� i; � � � �. s ` �n �=� -; , �� i�r� , �, ��:� �„ Tk �>' . �,. ,1� , 4� �*�� � ,�-t� �via i s �.� 'E�. ��K W�� ��+� � I p � . 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"' ' *' ,`t i' �.'E~ :.'� •.l`�� .F,y � '� .�-.a./� t•� I. � ��i . �.1� , y y�j' "�►� ,�I�ti�I�� �, ,�::� �;j� i � '� -a � t -+ ! � 1� � :r�..�y�+�� a �r�g, ,�;� •a , , f ,,� v� . �ys �♦ �, �.,.��.f+5r��' �` .{1n ��i�� � ,+�. .�. }{ �ys .i♦� �.r� � "�r,�,��t�Y ',�."�ii:r: ' � 'a !�r` �. 1:,•'� F�,� ' .• f �: ..-�.� . � � ' � •��`(• �'�' h ~ ,• i� ' '`a1� ��'►��''!tiF(� y�w1„`�✓✓�'f .� ,� <.t" . � ., �I"', �,' � � DAT TIME ` / CITY OF ORONO CALLED IN -� / �� INSPECTION NOTICE SCHEDULED S! /.� 6� P�RMIT NO. ���f-L�[�� OMPLETED ADDRESS ��P �� ���� OWNER TELEPHONE NO.�a'������ CONTRACTOR � �v �:�2� ��-i .S7Y0/1�-- � DESCRIPTION '�v � � �-� � � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORFJWETLANDS � ❑ FRAMING ❑ MECHANICAL FINAL 0 ❑ TREE REMOVAL Z ❑ INSULATION � WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB �WATER HOOK-UP ❑ PROGRESS � ❑ FINAL SEWER HOOK-UP ❑ COMPLAINT v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL Q OWNERICONTRACTOR TO MEEf YOU:_YES_NO Z � COMMENTS: �r� �SUr� ��'�y �� a � � �V L—�� / �i �A � ��/?- S��C G�-'�s[�y S��i� � J O �. � O � � � ;�i�' S � T— z W � W � � J � �M1IORKSATISFACTORY:PROCEED ❑ PROJECT COMPLEfE � W ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ PHOTOTAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (g52) 249-46�� OwnerlContractoron site: � �b`=� �' Inspector. � r White Copyllnspector's File Cenary CopylSite Notice