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Home My WebLink About2009-00401 (sewer & water connection) � CITY OF ORONO PERMIT NO.: 2009-0040� 2750 KELLEY PARKWAY ORONO, MN 55356- �ATE ISS[1ED: 07/09/2009 952 249-4600 FAX: 952 249-4616 ADDRESS : 3127 CASCO C1R PIN : 20-117-23-34-0022 LEGAL DESC : COLORADO SPRINGS : LOT 002 BLOCK 001 PERMIT TYPE : SEWER& WATER PROPERTY TYPE : RESIDENTiAL C01�1STRUCTION TYPE : CONNECTION NOTE: SEWER AND WATER CONNECTION APPLICANT CONCRETE SCIENCE SERVICES SEWER CONNECT/DISCONNECT/REPAIR 50.00 7545 COMMERCE ST. WEST WATER CONNECT/DISCONNECT/REPAIR 50.00 CORCORAN,MN 55340- STATE SURCHARGE SEWER&WATER 0.50 (763)420-4073 TOTAL 100.50 OWNER PETERS,FREDERICK 3127 CASCO CIR 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 sepazate permits. 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 I 0 days of the date of issuance,or if construction is suspended for a peri�of I 80 days at any time after work has commenced. The applicant is. s nsible for assuring all required inspections are requested in con r a e with the State Building Code.This permit may be revo t any i r u cause. A � � � b�i '7� � � C� plicant Per tee Signature Date Issu By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. , FOR�OSE ONLY ��0 ��j � � City of Orono Date�Keceived:7 Permit# 02. �//�'��O` P0. E3oz66 Y� '� 2ti0 Kelley Park�.�ay ❑In-House SAC Determination Form Completed ;�a y�� 7�, . �;.' Crystal Bay,hf\5�323 ��A�;,�: �,yu`,/ (952)249-4600 Approved By(If Required): ,`��` CITY OF ORONO—SEWER & `�'ATER/ GENERAL PERi�IIT (*Note� Some permits may requice approvaf by the Building Official and/or Public Works Department*) (ALL PER�IITS- �iav be sub'ect to further review and mav not be issued when the a lication is received) GENERAL INFORMATION 1. You may apply for utiliry permits by mail or in person at the City offices. 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 untit 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 Department(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY NIAIN without express approval of the Public��'orks Department. Issuance of a permit does not grant this approval. 7. All�vork must be done in accordance with State Code requirements. 8. All work must be inspected before it is covered. Call(952)2d9-4600,24+hour notice required. TYPE OF PERI�IIT (Check All That A lv � Residential(Ivlay Require Approval) � Commercial(Approval Required) [�New Connection ❑ Additional Connection ❑Re-Connection ❑ Repairs �Disconnect Job Site/ Owner Information: �� Site Address: �� t ��C� �� r� �� Owner: ��,��—.�-- I�lailing Address: City: _�r��— Zip: Hame Phone: Alternate Phone: Contractor Information: � / COl1C r�2 t5�. !�.h�-�._, �'�t; �G�'1--� Contractor: Contact Person: '1,�� C'c�mtti,� ��. r ''�.- Address: State License #: sS�� z -3 � - ��i Cit ��rC�r�"� Zlp: Expiration Date: Y� Phone: �� ' �2-��'�-�� Alternate Phone: 1!�� Z-' �� r a� � � DETERMINING PERMIT FEES ❑ SAC Charge(2009 Rate=�2,000.00) � (SAC Charge must accompany all sewer permit applicaticns unless prepaid) (Orono City Staff can determine if applicable) (If not prepaid,a sewer connection permit will not be issued) ❑ Sewer Connection/Disconnect/Repair(��0.00/Per Stub) � Pipe size inches,material Schd 40 air tested; cast iron ❑�'ater Connection/Disconnect/Repair(�50.00/Per Stub) $ — Pipe size inches;material Schd 40 air tested; copper 1. S[iBTOTAL of Permit Requested: $_ 2. STATE SURCH:�RGE $ �5� 3. POSTAGE&HANDLING(Only on I�1ail-In Applications) $ 2.00 4. TOTAL PER�ITT FEE(Add Lines 1-3 Above) $ ADDITIONAL INFORNIATION—WATER METERS ■ �'�'ATER METERS must be picked up and paid for at Orono City Hall,these are on a separate permit. ■ WATER 1�1ETERS 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. Applicant: ___ Date: �s � . Reset Form �� . . .. . .. DAT �IM � . ( �.f�� j � �' CITY OF ORONO CALLED IN � INSPECTION NOTI SCHEDULED -� PERMIT NO.c��-�� COMPLETED ADDRESS ��"�I C��> C--r�� OWNER `��`�C�'Cb CONTR. �G`C�c �.'�\C.Q TELEPHONE NO.�(Z� ��-C� � � I � DESCRIPTION �e�-�-� ��<<- �-� � ❑ FOOTING ❑ MECHANICAL RI ❑ EXCAV/GRADING/FILLING Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORENVETLANDS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ TREE REMOVAL Z ❑ WALL BD. ❑ WATE - ❑ SITE INSPECTION Q ❑ FINAL EWER HOOK-UP ❑ PROGRESS � ❑ DEMO-SITE . ❑ COMPLAINT Q ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP _ ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL J ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � `� � '��f � W P a � J O � � O � W � Q �� Z W � W � � � O � �ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑ CORRECT WORK,CALL FOR REINSPEC ON TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN INSPECTOR W4LL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED ❑ INSPECTION REQUiRED.CALL TO ARRANGE ACCESS. Call for the next inspecti 24 hour in adv e. 52 249-46�� OwnerlContractor on site: Inspector. White Copy/lnspector's File Canary Copy/Site Notice