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2014-00334 (sewer & water connection)
` A CITY OF ORONO * 2 0 1 4 - 0 0 3 3 4 * 2750 KELLEY PARKWAY DATE ISSUED: 04/18/2014 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2629 CASCADE LA PIN : 33-118-23-11-0114 LEGAL DESC : STONEBAY FIFTH ADDITION : LOT 004 BLOCK 001 PERMIT TYPE : SEWER& WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION NO"I�I�:: WA"fER �c SI:WER CONNECf10N APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 T& J CONCRETE WATER CONNECT/DISCONNECT/REPAIR 50.00 9100 BALTIMORE STREET NE STATE SURCHARGE SEWER& WATER 5.00 BLAINE, MN 55449- TOTAL 105.00 (763)413-0988 Payment(s) Minnesota State License #: SW-646112 CHECK 12865 ]05.00 OWNER BUILDERS LLC, STONEBAY 14870 BROCKTON LANE PLYMOUTH, MN 55446- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specitications,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 perntits. All provisions of laws and ordinances governing 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 requcsted in conformance with thc State Building Code.This permit may be revoked at any time for due causc. ,��.,6 �3.�� y� ��� , s!/ Applicant Permitee Signature Date Iss � F3y Signature Date �. . � t � _m�.��-FOR CITY USE ONLY ��Z��/V�, City�of Ot'Ooo Date Received Permit# P.O Box 66 \� 2750 Kelley Pulnti-ay ❑In-House SAC Detemiwat�on Form Completed �� � Crystal Bay,vfN 553?3 ; -:j''�, ��-' (9�?)249-4600 r Fax(95')?a9-4616 Approced By(IfRequired): ,,, CITY OF ORONO-SEWER & WATER/GENERAL PERMIT ("Note:Some permits inay requ�re appro�•al by tl�e Bwidan$Offieial and`or PubGc Works Department*) (ALL PERbIITS- llav be subiect to further reciew and ma��not be issued w6en the aapliration ix receiced) GENER.AL INFORMATION ' 1. You may apply for utility perniits by inail or in person at the City offices. Z. Mailed in applications are subject to tlie postage and l�andluig fee shown betow. Pennit cards��ill be sent by rehirn mail w�ithin 2 business days. 3. Permits ace uot��alid until you receive a permit cArd. 4. Work must not begui unless the permit card is acailable on the jab site. S. Utility coiuiection pennits may be issued to licensed contractors only. 6. Contact the Public Works Departnzent(952-249-4600)for utility shib as-built locations. DO 1VOT EXCAVATE IN A1�Y STREET A�TD DO?\'OT TAP A1�Y MAIiV'�r•ithout expi•ess appro��Al of the Public Works Depai�tment. Issuance of a permit does not grant dtis approval. 7. All work miist be done in accordance witl�State Code requirements. 8. All��ork must be uispected before it is covered. Call(952)249-4600,24+houc notice required. TYPE OF PERMIT Check All That A 1 (�Residential(May Require Approval} ❑ Commercial(Approval Required) [�Nev��Caiuiection ❑Additional Coiuiection ❑Re-Coimection ❑Repau•s ❑Discoimect ❑ Water A�-ailability Corwection For Future Hook-Up to Water Job Site/Owuer Inforivation: Site Address: oZl.�� ��-S�Ci �..QYISZ� Owner:c5�6YlQ. �a pj ,�1��.�Q� Mailing Address: CitY: Zip: Home Phoue: Alternate Phone: Contractor Iuformation: Contractor: Ta.�h Y 04 C C�ntact Person: �l�K -Jrt.(�,r6YYl� In�QSon ry� Address: �'j lC0 �ot.(,�i�'YtCnQ..5t /��. State License#: City: �YLX. Zip:��cJ Expu•ation Date: Phoue: �b�v-�f_�-6�1$$ Alteinate Phone_ (o)a �-�g5-��7 / � . t � DETERIViINING PERNIIT FEES ❑SAC Cha�ge{2014 Rate=$2,485,00) S (SAC Charge must accompany all sew�er pernzit applicatioiis untess prepaid) (Orono City Stat�can deteritiine if applicable) (If not pcepaid,a sewer connectioa permit w�ill not be issued) �.Sewer Conne tion/Disconnect/Repxi�• SSO.00/Per Stub) S Pipe size�inches;materia_1 ,_n�Schd 40 air tested; cast iron ��� �WAter Connection/Disconnect/RepAj,r($50.00/Per Stub) $ Pipe size�._inches:material ,,,1�t�s'chd 40 au•tested: copper �� ❑Wxter Availxbility For Future Hook-Up to Water(S50.00) $ Wate�'AYA'IIAblI�Iy ESpIaOAIIOD: Conh•actor installed line to inside of house for fuhue hook-up. This line will be inspected by the Public Works Department. E I Renuu•ed Before Water Connection Pet�niit is Issued: � 1. Issue Water Meter&Horn Pennit 2. Any Additional Cocuiection Fees Paid(IfApplicable) � � Issue Water Connection Peniiit: � 1. Collect Pe�mit Fee&Issue Water Connection Pennit 1. SLBTOTAL of Pe�Ynit Requested: $ 2. STATE SURCHARGE $ 5.00 3. POSTAGE&HANDLII`7G(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Luies 1-3 Aboee) S ADDITIONAL INFORMATION—WATER METERS �� • WATER METERS must be picked up and paid for at Orono City Hall,these are on a segarate uermit. ■ WATER METERS must be set aud sealed by Orono Water DepAiKiuent (952) 249-460Q, upou cotnpletlou of tuetei'�I1StRIIAII011. The undersigned hereby appli�s to the City vf Orono for issuance of a li tility Pennit, agrees to do all work in strict accordance with the ordina��ces of tlie City ancl the regulations of the State of Mumesota, and certifies thai all statements made ou tlus apglication a��e,hue u�d conect. 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' . °J`,l� . , ,. e , , . � . � � . � ik �.� � .i,Pcar;�?2 , �, ' �, ; k,,�.. �. . � +:�,-��� '� �� _`� .� �l •� ..�� � �...��M�,Tsi•' ��� `,r��� ��• '{�••�,�'���� ` � . �r�' ..� - ' � ._. � � � .... � , .. .,� �,�v,r . 9•�ti✓�,,,�^ � -. i�:. ��:�'�v �.#+ ri '� .M;P;'. t� :'�J. s.� M���ti�_'.aYa-...\�. - ..l`.t�:.*'!�'. � / .,, �/�i 4�(J L�/� � D TE TIME � CITY OF ORONO CALLED w � � � INSPECTION NOTICE SCHEDULED ! fl�-/'� PERMIT NO.� - connP�ErEo ADDRESS � a � OWNER TELEPHONE NO.�� 2-��5�7�7 CONTRACTOR `� � � � F� /IiL� � DESCRIPTION � �-��� � � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING � ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORENVETLANDS ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z O INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB WATER HOOK-UP ❑ PROGRESS � ❑ FINAL �SEWER HOOK-UP ❑ COMPLAINT J ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNbATION/REMOVAL 2 OWNERICONTFiACTOR TO MEET YOU:_YES NO � COMMENTS: �/�P��re �� ���C�/� a �� �V �" S�c G �C: .S��c.���- 0� �L � � J O �� o _,�, � /ov.� � W 2 � Q � ��-� ��cS W � w 2 J d WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE � ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN INSPECTOR WILL REfURN ❑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�0 OwnerlContractor on site:_T/✓ � Inspector. �� White Copyllnspector's File Canary CopylSite Notice