HomeMy WebLinkAbout2009-00191 - sewer/water connect CITY OF ORONO PERMIT NO.: 2009-00�9�
" � 2750 KELLEY PARKWAY
ORONO, MN 55356- DATE IssvEn: 04/30/2009
952 249-4600 FAX: 952 249-4616
ADDRESS : 2623 CASCO POINT RD
PIN : 20-117-23-24-0032
LEGAL DESC : SPRING PARK
: LOT 141 BLOCK 000
PERMIT TYPE : SEWER&WATER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : CONNECTION
NOTE: SAC PD WITH BUILDING PERMIT
APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00
KEVITT EXC. INC. WATER CONNECT/DISCONNECT/REPAIR 50.00
3335 PENNSYLVANIA AVE NO
CRYSTAL, MN 55427 STATE SURCHARGE SEWER&WATER 0.50
(763)545-3557 TOTAL 100.50
OWNER
KUBALAK,THOMAS&PATRICIA
2623 CASCO POINT 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 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 authorized is no[
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 in conformance with the State Building Code.This permit may be
revoked t any time for due cause.
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Applicant Permitee Signature Date Issued B ignature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB VE.
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FOR CITY USE ONI,Y
;¢0� City of Orono Date Received: Permit#
P.O.Box 66
����. � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed
�� �`'��• t�� Crystal Bay,MN 55323
�+,a�,y�e� (952)249-4600 Approved By([fRequired):
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CITY OF ORONO-SEWER& WATER/GENERAL PERMIT
(*Note:Some permits may require approval by the Building Official and/or Public Works Department•)
(ALL PERMITS- Mav be subiect to furt6er review and mav not be issued when the annlicatioo 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 iicensed 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 1�TOT 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
�'�esidential(May Require Approval) ❑Commercial(Approval Required)
❑New Connecrion ❑Additional Connection �'1Fe-Connection ❑Repairs �Disconnect
Job Site/Owner Information:
Site Address: �� � ? �" �'c " '�o ;.� f �'`/
Owner: � "�`' ��'` �a �<l �` Mailing Address: ��� 3 �" '"' �`'"� � '�`�
City: Or� , � Zip:
f'�// o�� - cv v 7 7
Home Phone: Alternate Phone: �� � -�
Contractor Information:
Contractor: �� v' � � �X�"v`j ����Contact Person: �"�`�`� �4 `lG'�
��35" Y'nnJ� 'ic:.�'�r.
Address: f�"r �! State License#:
�sv?�
City: Cr�' ��' � Zip: Expiration Date:
Phone: �� ''""' �s - �5 � � Alternate Phone: ���" �"s -�� "3 3
�C �-, �� Cr!!
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DETERMIN]lNG PERNIIT FEES
❑SAC Charge(2009 Rate=$2,000.00) �
(SAC Charge must accompany all sewer permit applications unless prepaid)
(Orono Ciry Staff can determine if applicable)
(If not prepaid,a sewer connection permit will not be issued)
�'S�ewer Connection/Disconnect/Repair($50.00/Per Stub) $
Pipe size inches;material 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. STAT'E SURCHARGE $ .50
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
ADDITTONAL iNFORMATION-WATER METERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a s�arate 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
aii 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 conect.
30 —O
Applicant: ��� Date: yr �
Reset Form
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� � � � KEvitt Excavati n l.l.0 �
9
3335 Pennsylvania Avenue N. • Crystal,MN 55427 • (763)545-3557 • Fax: (763) 545-5235
�t,
Th`s card certifies that the cardholtier �
MUCA Pipelayer Training Certificatior�, has cdmpleted training in the require are '
j � BRAD HALL of th�e Minnesota Plumbing Code re ate+�
� '� to�Pipe Laying as determined by t e �
� _____ innesota De artment of Heal '•
,4�, has completed the Pipe Laying Trainin g --__ p ________t
( ��.- Course through the
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� �� Card Number. .1
r='»+Viinn ��y�Cont c� A55ociation O�6 3
� �and is a Certified Pipe Layer having completed Mlnneeota Utfflty Gontractors ASeocl tlon
i�� required course work in pipe laying and the 6043 Hudson Road,Sufte 378,Woodbury,M 5�1
Minnesota Plumbing Code (6511)735-3908, 1-800-567-MUCA (651)735 i 018(
I
t�intrr�so-r�r��P,��z�-nn�rv�'a� :
� Plumbing Bond & Insurance Certificate
�
LAB4R & (NI�E.l�T�TY , <
Construction Codes and Licensing Division Licensing artd Gertification Services 443 Lafayetfe Road N St Paul,MN 55155
Website: www•dolistate.mn.us E-maiL DLI License�state.mn.us 7elepttone: 651-284-5080
This is to certify thatthe certificate hoTder is in compfiance with Minnesota Statutes§3266.46,Subd.2 for calendar year 2009 and may
engage in building sewer and waterservice installation in all areas of the stafe of Minnesota.
BRAD J HALL ��� Certifiec��Pipefayer
.
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KEVITT EXC�►Vi�TING.LLC '
� �' 3335 PENNSI�LVAI'�fIA`�AVE � � u� z'��� < �
G�LDEN VALLEY, MN 55427
Bond ID: 55 188442 Liability Insurance ID: 55188442
2 O O V UNITED FIRE AND CASUALTY COMPANY WESTERN NATIONAL INSURANCE
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CITY OF ORONO cA��Eo w ���� D � �
INSPECTION OTICE SCHEDULED � �_ �v
PERMIT NO. - �l l COMPLETED
ADDRESS
OWNER CONTR. �!,G -
TELEPHONE NO. %2�� - ��P.3 - ��J - r��J� 7
� DESCRIPTION v�/G����L�/Y�- l�/2��Y(
� ❑ FOOTING ❑ MECHANICAL RI ❑ EXCAV/GRADING/FILLING
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORENVETLANDS
� ❑ 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
v ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP
� ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL
J ❑ PLUMBING FINAL ❑ FOUNDATION/REMOVAL
Q OWNERICONTRACTOR TO MEET YOU:_YES_NO
� COMMENTS: c,�1� 1 C� �� C (C �r��
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GW �f VfIORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE
W ❑CORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY
� ❑CORRECT WORK,CA�L FOR REINSPECTION TEMPORARY
� BEFORECOVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN
INSPECTOR WILL REfURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS.
Call forthe next inspection 24 hours in advance. (952� 249-4600
Owner/Contractor on site:
Inspector. `..� i'"���
White Copyllnspector's File Canary CopylSite Notice