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2013-00662 - sewer disconnect
. �` CITY OF ORONO * z 0 1 3 - PJ 0 6 6 Z * ' 2750 KELLEY PARKWAY DATE ISSUED: 07/17/2013 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 3884 CHERRY AVE P[N : 08-117-23-33-0084 LEGAL DESC : CRYSTAL BAY VIEW : LOT 000 BLOCK 003 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 LCS STATE SURCHARGE SEWER& WATER 5.00 7207 W 128TH ST SAVAGE, MN 55378- TOTAL 55.00 (612)363-1246 OWNER ENGLUND, DOUGLAS 3884 CHERRY AVE P.O. BOX 285 MOUND, MN 55364- AGREEMENT AND SWORN STATEMENT The work for which[his 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 docs not grant permission for addi[ional 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.']�his 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 atter work has commenced. Thc applicant is responsible for assuri g all required inspections are requested in conformance with he.' • e ailding Code.'rhis permit may be revoked at ai Ume tbr due se / / / / Ap licant ermitee Si natur . Date Issued B ,ignature SEPARATE PF.RMITS REQUIRED FOR WORK OTH THAN DESCRIBED ABO E. ___ H�oK crr��USL otii.�� j`�g-�l�I \� Clty Of�COIlO Date Received: � � Permit M � �' � \ P.O.Box 66 ` 2750 Kelley Parkwa}° ❑ In-House SAC Detcrmination E�rm Completed � � � Crystal Bay,MN 5�323 \y ^ ��F� _ %� (952)249-4600 � Approved�By(IfRequired): �?a-f-cito��,� i. . � - � CITY OF ORONO - SEWER & WATER/ GENERAL PERMIT (*Note:Some permits may require approval by the Buildina Official and/or Public Works Department*) (AI.L PERMCCS- Ma��be subiect to further review and mav not be issued when the aonlicatimi is reccived) GENERAL INFORMATION 1. 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 handlinb 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 wark must be done in accordance with State Code requirements. 8. All work must be inspected befare it is covered. Call (952)249-4600.24+hour notice required. TYPE OF PERMIT (Check All That Apply) [(,]�P�esidential(May Require Approval) ❑ Commercial(Approva] Required) ❑ New Connection ❑ Additional Connection ❑ Re-Connection ❑ Repairs ❑ Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job S�ite/ Owner Information: Site Address: � � � _ ,�� (/Q �d Owner: �o�-� �.� H�,�y �,�/ Mailing Address: _ j �b' ��c',�✓� /¢r/ City: �,�a���� � Zip: C�✓r�v G'�� Home Phone: I`7 p��3� -�(��� Alternate Phone: Contractor Information: I Contractor: l.� C � Contact Person: U/�> �/`�,� � Address: �0�1>`7 1� /�� State License #: �GDD�-37 (� �---� City: � � �. Zip: �1 �/l�xpiration Date: 3-3 � - � � Phone: � �� '� � -� �� Alternate Phone: � �,� � �� 3 ' / v�.y� t. ' L��'�:'E . . , ����R�TT F��" : �� �. f � � .. . ❑ SAC Charge(2013 Rate=$2,435.00) $ (SAC Charge must accompany all sewer permit applications unless prepaid) (Orono City Staff can determine if applicable) (lf not prepaid,a sewer connection permit will not be issued) �Sewer Connection isconnect/Repair($50.00/Per Stub) $ �� . � � Pipe size in erial Schd 40 air tested; cast iron ❑ Water Connection/Disconnect/Repair($50.00/Per Stub) $ Pipe size inches; material Schd 40 air tested; copper ❑ Water Availability For Future Hook-LJp to Water($50.00) $ Water Availabilitv 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: $ "��' � n 2. STATE SURCHARGE $ 5.00 3. POSTAGE&HANDLING (Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE (Add Lines I-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 i��str`ict,accor.danc� with�hhe�ordinar�ces of.th•e City and the regulations of the State of Minnesota, and certifies that all state nts made on this application are,true and correct. . Applicant: Date: DATE TIME V CITY OF OkONO CALLED IN �7 �7-� INSP��TION NOTICE 1 SCHEDULED 7-1 S-/ '� ��U PERMIT NO. ��3-�D��v�COMPLETED ADDRESS �� ���" C��1.2YYL1 A'1/�l'l �-C:�_ OWNER n,, T L PHONE NO. CONTRACTOR r v� �" �y`- L eS � DESCRIPTION C�'�il/I/�/� ��GL.�� � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORENVETLANDS 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 v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL Q OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: �t �( G�Li � CiV� � C/�-� g�yj � -.� � � � O >. � O / Q W � Q ti Z W � W � � a � ❑WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W ❑CORRECT WORK&PROCEED G ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. 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