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Home My WebLink About2014-00541 - sewer disconnection � CITY OF ORONO * 2 0 1 4 — 0 0 5 4 1 * � 2750 KELLEY PARKWAY DATE tssUEn: 06/02/2014 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 1645 BOHNS POINT RD PIN : 17-117-23-11-0007 LEGAL DESC : REG. LAND SURVEY NO. 0565 : LOT 000 BLOCK 000 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER& WATER 5.00 UNLIMITED, INC. TOTAL 55.00 19960 ST FRANCIS BLVD payment(s) ANOKA, MN 55303- (763)753-9867 CHECK 1008 55.00 OWivER CHURCH,JOHN & KLERISSA 1645 BOHNS PT RD WAYZATA, MN 55391- AGREEMENT AND SWORN STATEMENT �t�he work for which this permit is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the State Building Codc. This pennit is for only the work described and does not grant permission for additional or related work which requires separatc permits. nll provisions of laws and ordinances goveming this type of work shall be compied with whether or not specified herein.This permit will expire and become null and void if construetion authorized is no[ commenced within 180 days ot�the date of issuance,or if construction is suspended for a period of 180 days at any time after work has commenced. Che applicant is r ponsible for assuring all required inspections are requested in c 'ormance with the State Building Code.'Chis permit may be revoked at� time for due cause. ,�// �n,��% /G-.L� _ v l l A�pplicant Pe� ' �gnature Date Issued ignature Date � �� } � �—:,A�` FOR CITY USE ONLY ,�.-��-�-�+�=�„l C'lty of OI'ono Date Received: Permit# f �"`�� P.O.Box 66 � �� 2750 Kelley Parkway ❑In-House SAC Determination Forxn Completed ,� � ' � Crystal Bay,MN 55323 ��_' '��'� ^� (952)249-4600/Fa�c(952)249-4616 � Approved By(If Required): .'`e`��-;'�..:.='�',.� CITY OF ORONO— SEWER& WATER/ GENERAL PERMIT (*Note:Some permiu may require approval by the Building Official andlor Public Works Department`) (ALL PERMITS- Mav be subiect to further review and mac not be issued when the apuGcation is received) GENERAL 1NFORMATION 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 unril you receive a permit card. 4. Wark 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 a.�-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 ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address: �� l�Oh��S f�or��{- �c� Owner: ��l�t rG�1 Mailing Address: City: � TO/JU Zip: Home Phone: Alternate Phone: Contractor Information: 1�t�1�1/hi �c'c� 1��• ContactPerson: HUCl,M u/�TL'r{-S Contractor: � Address: I y�/�/i S},�t"crnC,'s h��c/ State Lieense#: I' ��Z� ��y City: ,�nOl�� Zip5j.3u ExpirationDate: ��! ��a'��5 Phone: ��3��/�"� ?��0 Alternate Phone: � � DETERMINING PERMIT FEES ❑ SAC Charge(2014 Rate=$2,485.00) $ (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) r-, Sewer Connection/Disconnect/Repair($50.00/Per Stub) $ ��G�-U(� Pipe size L�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 flook-tip to Water($50.00) $ Water Availabiliri�Explanation: Contractor installed line to inside of house far future hook-up. This line wil]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: $ ((J(�-(�(� 2. STATE SURCHARGE $ 5.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �C� �G�(� ADDITIONAL INFORMATION-WATER METERS ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separatepermit. ■ 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 accordanc with the ordinances of the City and the regulations of the State of Minnesota, and certifies at all statements made on this application are,true and correct. /,,. l/'��'�-.� t�/ Applicant: � ( Date: ��v�� O / S� D E TIME � CITY OF ORONO CALLED IN 6 � INSPECTION OTI E SCHEDULED �l� /6:0� PERMIT NO.�� -dD S Z'COMPLETED ADDRESS l�OTS �Dv[�Yi,O � � OWNER TELEPHONE NO. CONTRACTOR �n�m ��C� �/'1 C, >; DESCRIPTION S��'�- � � � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORENVETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL Q ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE O SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ��SEWER HOOK-UP �R.,r�/,� / ❑ COMPLAINT � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL D HARD COVER REMOVAL J � PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNbATION/REMOVAL 2 OWNERICONTRACTOR TO MEET YOU:_YES_NO c�., COMMENTS: � W 0. j � � 1 � /� �`G� � ;� d 0 � W � � �S A� Q ..1; � .� ( � � � ��,� f�c� tti ( -�%,�(i->l �'i � 1 � d W� ❑WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLEfE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORE CWERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. /�,w�TO TAKEN INSPECTOR WILL RETURN ,o��"� ❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED ❑INSPECTION REOUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 2a�ours in advance. (g52) 249-4600 OwnerlContractor on site: r�/;�f j� /� Inspector. Ot-f1,� White Copyllnspector's File Canary CopylSfte Notiee