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2013-00777 - sewer connect
� ` CITY OF ORONO * 2 0 1 3 - 0 PJ 7 7 7 * 2750 KELLEY PARKWAY DATE ISSUED: OSJ07/2013 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 1510 NORTH A1Z1Vr15R �'��' �`") S�> C'�2�1.��' t-��-'�. PIN : 08-117-23-33-0078 LEGAL DESC : HICKORY HILL ; LOT 020 BLOCK 000 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION NOTE: SEWER CONNECTION 4" PIPE S[ZE-SCHD 40 PVC APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 J. P. SCHMITZ CONST. CO., LLC STATE SURCHARGE SEWER& WATER 5.00 16450 l 17TH AVE N MAPLE GROVE, MN 55311- TOTAL 55.00 (763)286-1995 Minnesota State License#: PB645863 OWNER Real Assets LLC 550 25TH AVENUE N ST CLOUD, MN 56303- AGREEMENT AND SWORN STATEMENT I�he work for which this pem�it is issued shall be performed according to thc approved plans and specitications,applicable City approvals,�nd the State[3uilding Code. This permit is for only the work described and does not grant permission tbr additional or related work which rcquires separate permits. All provisions of laws and ordinances governing this type of work shall be compied with whether or not specitied herein.This pern�it will expire and become null and void if construction authorized is not commenced within 180 days of the date of issuance,or if construc[ion is suspended for a period of 180 days at any time afrer work has commenced. The appl' i p si e r assuring all required inspections are re sted i r a e wi tate Buildl�g Code.This permit may be re ked a e e ause. . / / � � �� � � � licant Permit�e Si e Date Issue y Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. FOR CI"1'1'USL ONLY J���-�N � Clty Of 01'ono Date Received: __ PermiL# ' � \ P.O.Box 66 f �, { � , 2750 Kelley Park��a} ❑In-House SAC Determination Form Completed �.. �;� Crystal Bay,MN��323 � ��' 952 249-4600 A roved B 1 f Re uired � ��� � ' � ) PP Y� 9 �� I ��h'is'tro�';" 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 further review and mav not be issued when the aoalication is received) '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 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 contraetors 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) ��� � � � �Residential(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: �/� C, �f'�', �/����� Owner: /'��L�� /�����"��� Mailing Address: l���� City: ����'1��/�,� Zip: �j�"`�� � � � � . Home Phone: ��5"" � �� Y�� Alternate Phone: Contractor Information: � Contractor: ��t<<�/������L�t Contact Person: ��� Address: ��7�v /�7�/�f'�/� State License #: �����0�� ��6� � City: ����i�1�� Zip: Expiration Date: Z . L��.S Phone: 7G� JZ���� Alternate Phone: � \�� ��*`� . � � E����J.����������.4���.J ;/ .'�g� yw `;� �..x-�: ❑ SAC Charge(2013 Rate=$2,43�.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 wilt not be issued) �Sewer 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 ❑ Water Availability For Future Hook-Up to Water($50.00) $ Water Availabi(itv Explanation: Contractar installed line to inside of house for future hook-up. This line will be inspected by the Public Warks 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 l. SUBTOTAL of Permit Requested: $ 2. STATE SURCHARGE $ 5.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERI�ZIT FEE (Add Lines 1-3 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 Citx of Orono for issuance of a Utility Permit, agrees to do all work,i� s,tt'ict,accor.danc� with'the�ardina�ces of.th•e City and the regulations of the State of Minnesota, aud certifies that all statements made on this application are,true and correct. � Applicant: Date: ��'�� W � �`�- � or(� _ /� V CDAT� TIME CITY OF ORONO CALLED IN d � INSPECTION NOTIC �HEDULED �Z3 � PERMIT NO.d�/�-DD 7 7 /oMPLETED — ` ADDRESS � �S�D Gr��� �� � �'�� � OWNER �' ELEPHONE NO. 7�3 �� � ���5 CONTRACTOR VD�"�( cJ �: DESCRIPTION C��!�.��� � ❑ 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 J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO r �/ � COMMENTS: � ,Sc.� c1 o DcJ C .�-cJ��r S�/r�i�P a s il � e j �+ O " �. � � r 0 � � � � �f , Q � z W � W � � d W ❑WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE � ❑CORRECT WORK 8 PROCEED G ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. C PHOTO TAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �95ZLZ49-46�0 OwnerlContractor on site: �`e ' �'I/� � Inspector. White Copyllnspector's File Canary CopylSite Notice s' . . ► �'�`�, ,� ,v:: ' _ � ' � _ � ,� � + � . , �.� �� .��'.° M � � ,� �� °�. �� �����"���:;°,y b G%r.�, "_t-y ��`�r`��� �rt ..;C l� t �{ ��r . , p�kI"d n pk',. � S� Yy't•�? ��, ` � A�" `�',e ��`` 'R :r,+ '�' T' ' � �"� '"a Ny., � � a�"�,,� .�1�; {.� . . ��'� ,�, . _y+ '� #t��"� ,� '�.'� r��`�.� w tl�i x� �,��'�,,-' y � �� . t�, .�y � �,: �.�'" 4y: +�'- �r e �� � ,yr . 4 +�"'� � { v���:i � +'1��p ��a*�; �5a�r„_ Vd, wt� �' �7^iR�d�'���'�_6����}�'���+0.��I����r� �, .. ,�, . a 'Y��s�r„'r �`�a � ,�. _.i���'a� ���q,��.'`�, a Wt � � *"'h��� , . . . �,. Va'i � fk t F",{�r.sy�y .� �� �}^ . 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