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Home My WebLink About2009-00580 - sewer & water CITY OF ORONO PERMIT NO.: 2009-00580 � � 2750 KELLEY PARKWAY ORONO, MN 55356- �ATE ISSUED: 09/1 U2009 952 249-4600 FAX: 952 249-4616 ADDRESS : 200 BEDERWOOD DR PIN : OS-117-23-12-0027 LEGAL DESC : AUDITOR'S SUBD.NO.203 : LOT MB BLOCK MB PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 CONCRETE SCIENCE SERVICES WATER CONNECT/DISCONNECT/REPAIR 0.00 7545 COMMERCE ST. WEST CORCORAN,MN 55340- STATE SURCHARGE SEWER&WATER 0.50 (763)420-4073 TOTAL 50.50 OWNER AZAD, ALISHAH 200 BEDERWOOD DR LONG LAKE, MN 55356- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specitications,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 not commenced within I80 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 aIl required inspections are requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. / / / / Applicant Permitee Signature Date Issued By Si ture SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB V . FOR CITY'USE ONLY �'0'� City of Ol'Ono Date Received: PenniC# �O¢ �O, P.O.Box 66 �,,.,__ � 2750 Kelley Parkway ❑In-House SAC DeterminaCion Form Completed ��,{ ry'�'�• - �'� Crystal Bay,MN 5�323 '�9 Y,� i, ., A." `��+�,n�:*�o';� (952)249-4600 Approved By(If Required): �+aao,. CITY OF ORONO—SEWER& WATER/GENERAL PERMIT (*\ote Some permits may require approval by the Building Official and/or Public Works Department*) (ALL PER�1ITS- Mav be subiect to further review and mav not be issued when the application is received) GENERAL INFORMATION 1. You may apply for utiliry permits by mail or in person at the Ciry 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 A 1 ) � Residential(May Require Approval) � Commercial(Approval Required) ❑ New Connection ❑Additional Connection ❑Re-Connection ❑ Repairs � Disconnect Job Site/Owner Information: �� Site Address: ��0 Owner: Mailing Address: City: Zip: Home Phone: Alternate Phone: Contractor Information: v � Contractor: h�� .� Q�41(R, Contact Person: ` 6 �� Address: '�S � � State License #: Cit r�0✓Gl,h Zi � y: p: .�5�� Expiration Date: Phone: ��p� " `t'� �0�"3 Alternate Phone: �.'1�Z! Z,0� ��-3 � ' DETERMINING PERMIT FEES ❑ SAC Charge(2009 Rate=$2,000.00) $ (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 Connectio Disconnect/Repair($50.00/Per Stub) $ � Pipe size inches;m enal 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 ofPermit Requested: $ 2. STATE SURCHARGE $ .50 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT 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 City of Orono for issuance of a Utility Permit, agrees to do all work in strict accordance with the or a s of the City and the regulations of the State of Minnesota, and ce fies that all s atemen on this application are,true and correct. Applican . Date: —( �O Reset Form �' �� ATE TIME � � CITY OF ORONO CALLED IN IO � INSPECTION N�O/�T�I,C�E SCHEDULED / � � PERMIT N0..7'V[J"1-�S� OMPLETED ADDRESS � J �� /��C>� I((/,��(/�-�/ OWNER CONTR.��/J1�.� /�f�G� TELEPHONE N0. �C J � � � DESCRIPTION �� Z/ ^ � �� ❑ FOOTING � MECHANICAL RI ❑ EXCAV/GRADING/FILLING Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORENVETLANDS y ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ TREE REMOVAL Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION Q ❑ FINAL �WER 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 � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W a � - � `� r�� C,�,�� ( 0 � r� ^ � ° � J O .�-- � W � Q �:? �- �-�C� �� r 1� �, I 1<�� z w � W � � � i'�WORK SATISFACTORY:PROGEED C� PROJECT COMPLETE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. C PHOTOTAKEN INSPECTOR WILL RETURN ❑ CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Cail forthe nexi Fnspection 24 hours in advance. �952� 249-46QQ OwnerlContractor on site: '' Inspector. ! � � � White Copyllnspector's File Canary Copy/Site Notice �� `�� DAT TIME `� CITY OF ORONO CALLED IN I � INSPECTION NOTICE SCHEDULED z� PERMIT NO.�-�D S�OCOMPLETED �� ADDRESS .-�Z��i �.�1�? �� . OWNER CONTR. �Q CdY,Y'�;t'0 TELEPHONE NO. �� - ��J -V� f I �,�� DESCRIPTION �.t��h �u4C'(��'I�� ❑ FOOTING ❑ MECHANICAL RI ❑ EXCAV/GRADING/FILLING Q ❑ FR,4MING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETLANDS y ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ TREE REMOVAL Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPIAINT � ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP i ❑ PLUMBING RI ❑ SEPT C FINAL ❑ HARD COVER REMOVAL J ❑ PIUMBING FINAL ❑ FOUNOATION/REMOVAL � OWNERICONTRACTOR TO MEET YO YES_NO � COMMENTS: � W a � 0 l /`�-t� � � � O �_� . W � Q � Z W � W � j d W� ORKSATISFACTORY:PROCEED CI PROJECTCOMPLETE W ❑ CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Ca11 for the next inspection 24 hours in advance. (952� 249-4600 OwnerlContract s' Inspector. White Copyllnspector's File Canary CopylSite Notice