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HomeMy WebLinkAbout2013-00994 (sewer & water disconnect) , _ CITY OF ORONO * 2 0 1 3 - 0 0 9 9 4 * 2750 KELLEY PARKWAY DATE ISSUED: 09/25/2013 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 3227 CASCO CIR PIN : 20-117-23-43-0018 LEGAL DESC : SPRING PARK : LOT 026 BLOCK 000 PERMIT TYPE : SEWER& WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION NOTF,: SGWER AND WATER DISCONNECT APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 D.S.M. EXCAVATING WATER CONNECT/DISCONNECT/REPAIR 50.00 2916 ENTERPRISE AVE HASTINGS, MN 55033- STATE SURCHARGE SEWER& WATER 5.00 (651)480-1355 TOTAL 105.00 PAID WITH CC# 9252 OWNER O'ROURKE, JAMES 3227 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[he work described and does not grant permission for additional or related work which requires separate 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 au[horized is not commenced within 180 days of the date of issuance,or if construction is suspended for a period of I 80 days at any time after work has commenced. "�he applicant is responsible for assuring all required inspections are requested in conformance with the Sta[e Building Code.This permit may be revoked at any ti e for due cause. � �° � � a.s � l3 ��,���� �' ��-i � > Applicant Permitee Signature Date Issued, �y Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. ' ��.�.� d CI Y USE ONLY ��n/� CltyofOrono DateReceive����!'�Permit# �-,d -rl'�/ P.O. Box 66 27�0 Kelley Parkway ❑ In-House SAC Detemiination Forni Completed '��, i � Crystal Bay,MN»323 �-'�,�kY�tF����� (952)249-4600/Fax(952)249-4616 Approved By(If Required): �;ii� CITY OF ORONO — SEWER & WATER/ GENERAL PERMIT (*Note:Some permits may require approval by[he Building Official and/or Public Works Department*) (ALL PER��IITS- llav bc subiect to further review and mav not be issued when the anplication is received) GENERAL 1NFORMATION I. You may apply for utility 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 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 Department(952-249-4600) for utility stub as-built 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 Apply) �esidential (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: �3 a �� GGvup �• Owner: Q I�c►�,�.Q, Mailing Address: City: Zip: Home Phone: Alternate Phone: Contractor Information: Contractor: 1�•s•(�'l • �,�-C_• Contact Person: I�l�,� �P /�Yl� Address: a--9.l� F',�.,�,�.J!�( State License #: a--Z � 8 City: � Zip: Expiration Date: Phone: G SI��lBG r�3S� Alternate Phone: � ��'- � ��-��3��G DETERMINING PERMIT FEES ❑ SAC Charge(2013 Rate=$2,435.00) $ (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) � Sewer Connect' Disconnect/ epair($50.00/Per Stub) $ Pipe size +nches; matena Schd 40 air tested; cast iron �ater Connec istr/�Disconnect epair($50.00/Per Stub) $ Pipe size �nches; material Schd 40 air tested; copper ❑ Water Availability For Future Hook-Up to Water($50.00) $ Water Availability Explanation: 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: 1. 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 Permit Requested: $ ��� �' 2. STATE SURCHARGE $ 5.00 3. POSTAGE& HANDLING (Only on Mail-In Applications) $ —�-98 4. TOTAL PERMIT FEE(Add Lines I-3 Above) $ � � � �Z—` 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 tlle ordinances of the City and the regulations of the State of Minnesota, and certifies tl at all statements made on this application are, true and correct. (M�' _ �.s-13 Applicant: Date: �1 - _ i(i���'��' il IUIR��� li� � �: � �` ;;�°� � �� � _"'�`�� �� � , � d�' � �� �� � ;� � � �. �,�� •� =w�. * � � t,� .� � .�� ��'�' � , �: 4 � :� �� � .n, �.� �; �9. � - - b . , , � � � �"� � �� :� �;: < � � �. " `�� � � � ��� , . - . '.. � , ,., � ^�,,,�`: • �, .; � `r� �;;� �' �� `� • •• �, � . � � � ��„ : . ; �y'.'.� h G �� �- ,E k -. � ..� u < � �3' . •• . '.r . ��t \. .. A . �rP, .�. � [ .. .�y j�:fY � �' . �ay� s� - .d" . `'� t . . . . . . �. ..� .� ..x ��.,. �., � p� . � ��. 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'R' ,d =. /•�c�� . 11 �� $'�Fwle' ,/ .�'M1� �� '� �� '�� � .� ,.Y1..�''�. ..�F, x� 5� q'-: '}� � s,��� k r 4� . ..a�,a; � '-ky, s�K Y ; .' ,�"�t .e'vyw . ._.��C�i�A..•, • �•� s� ,�, W ••� �a. �' i 1 � � �11w'..� r `. � a �,,/ � ':� 0 y • K M Y d w` 4� a �k V� , � ti �A. i�'�..� 3-��. ,, _ .< ��'�,�a.. ,'��. .��"'�.+'�,::. . , �,:`' .. '�$"�i,:, �,;,,,'° `. ����:�-� ,� � DATE TIME � CITY.OF ORONO CALLED W ` '/� INSPECTION NOTICE �j SCHEDULED 6�f—1 3 :a�3 PERMITNO.�d�3��` � COMPLETED ADDRESS �� � OWNER TELEPHONE NO. '` g CONTRACTOR -5 i��� �: DESCRIPTION �(J N S �S � � � ❑ FOOTING ❑ PLUMBING FINA� ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICALRI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP � ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � �� �'i��F�� �- S w� s,L✓�6��c�� � .. a /?.s��- 6P/6w Gv�--l..�..e • � S�w..�� s����� �s y '� /s¢y �%�e c�o�o�� � (iU/� .� S��� ��'/1/Ca d/�-S�� � �y � _ 0 � W � Q � z W � W � � d W� . ORK SATISFACTORY:PROCEED Ci PROJECT COMPLETE W ❑CORRECT WORK&PROCEED G ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORE COVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pHOTOTAKEN �NSPECTOR WILL RETURN ❑ CITATION ISSUED ❑STOP ORDER POSTED.CALI INSPECTOR O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Cail for the next inspection 24 hours in advance. �952� 249-46QQ Owner/Contractor on site: � Sh� �Y�, �'"D�i� Inspector. s��- ,. White Copylinspector's File Canary CopylSite Notice