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HomeMy WebLinkAbout2009-00591 (sewer repair) � CITY OF ORONO PERMIT NO.: 2009-00591 2750 KELLEY PARKWAY ORONO, MN 55356- DATE IssuEn: 09/15/2009 952 249-4600 FAX: 952 249-4616 ADDRESS : 2520 CASCO POINT RD PIN : 20-117-23-21-0017 LEGAL DESC : TOWNSITE OF LANGDON PARK : LOT 004 BLOCK 006 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : REPAIR NOTE: SEWER REPAIR APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 OUVERSON EXCAVATING P.O. BOX 702 STATE SURCHARGE SEWER& WATER 0.50 BUFFALO, MN 55313- TOTAL 50.50 (763)479-0337 Minnesota State License#: 68968 OWNER ROCCA, MR.&MRS. 2520 CASCO PT RD 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 rela[ed work which requires separate permits. All provisions of laws and ordinances governing this type of work shall be compied wi[h whether or not specified hecein.This permit will expice 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 requested i ormance with the State Building Code.This permit may be revo t any ti� e for due cause. � l / l �'JS � ljlS / d p ic ermitee Signature Date Issu y Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. FOR CITY USE ONLY "��''—��"`� Clty Of 01"OIIO Date Received: Permif# //,�,O�\�, � P.O.Box 66 ��'/��,; , �" 2750 Kelley Parkway ❑In-House SAC Determination Form Completed �a jr'� x+". i� Crystal Bay,MN 553'_'3 � �`��y fi ��y.+a`�f (952)249-4600 Approved By(If Required): .. a�scoay� �:__-� CITY OF ORONO—SEWER& WATER/ GENERAL PERMIT (*Note:Some pemiits may require approval by the Building Official andior Yublic Works Department*) (ALL PERMITS- Mav be subiect Yo further review and mav not be issued when the eonlication is received) GENERAL INFORMATION l. 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 Deparnnent(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE Il\'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 A 1 � �Residential (May Require Approval) �Commercial (Approval Required) ❑New�Connection ❑Additional Connection ❑Re-Connection �Repairs � Disconnect Job Site/Owner Information: Site Address: 2 � Z�% �4 S � v �tU/.� � �.�C Owner: �`� ^ � �' < < y Mailing Address: � � Z � �s s�r �'U, , � � Ciry: ��To •� o Zip: Home Phone: Alternate Phone: � � Z ��� U � �8 Contractor Information: " � '�.� � —�- Contractor: �.;�5�„ S�,>e� ,�- �� Con�ctPerson: �f o Address: P� �oX �� Z State License #: � �c��i� � / City: `� �I' Zip: ��/lf Expiration Date: � � Phone: � / Z 7 S � —6��'� Alternate Phone: 3�,r :��.. . . . . DET:ERT�INT�TG PERMIT FEES ❑ SAC Charge(2009 Rate=$2,000.00) $ (SAC Charge must accompany all sewer permit app]ications unless prepaid) (Orono City Staff can determine if applicable) (If not prepaid,a sewer connection permit will not be issued) ''�`Sewer Connection/Disconnect/Repair($50.00/Per Stub) $ Pipe size `� �� inches;material Jo I�-Schd 40 air tested; cast iron ❑Water Connection/Disconnect/Repair(�50.00/Per Stub) $ Pipe size inches;material Schd 40 air tested; copper 1. SUBTOTAL of Permit Requested: $ 2. STATE SURCHARGE $ .50 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines l-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 certifi a tatements made on this application are,true and correct. � � Applicant: � �� Date: � � � � � ^� Reset Form ,�p'. ww�., . '[._g.�. - a.ri�� �-- • .8i b , �.•�. p� . ��., µ._,e � �' . . ' � "�yy�;: �.`t�:� .. 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G�L • TELEPHONENO�D — l0� —�cS—�� �O D � DESCRIPTION G�IJ C�� � ❑ FOOTING ❑ MECHANICAL RI ❑ EXCAV/GRADING/FILLING y ❑ FR,4MING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETLANDS O ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ TREE REMOVAL Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT Q ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FO�LOW-UP _ ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL � ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W a � J O ' '' ��GU' '�� /� � 0 � w � � Q � z � � " ,.�cd W � jG�i �-� �!o !'��d.��r � d W� ❑WORK SATISFACTORY:PROCEED PROJECT COMPLETE W ❑CORRECT WORK&PROCEED ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION � TEMPORARY V BEFORECOVERING PERMANENT ' ❑CORRECT UNSAFE CONDITION WITHIN HOURS. G PHOTO TAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS. Call for the next inspection 24 hours in advance. �95Z� Z49-4600 Owner/Contractor on site: Inspector. .�'� White Copy/lnspector's File Canary Copy/Site Notice