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HomeMy WebLinkAbout2015-01153 - re-connect CITY OF ORONO * z 0 1 5 - 0 1 1 5 3 * . 2750 KELLEY PARKWAY DATE ISSUED: 09/10/2015 � ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2450 COBBLESTONE CT PIN : 33-118-23-11-0082 LEGAL DESC : STONEBAY SIXTH ADDITION : LOT 004 BLOCK 001 PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : RE-CONNECT NOTE: SAC PAID#2015-00800 APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 WATER CONNECT/DISCONNECT/REPA[R 50.00 BOLLIG&SONS, [NC. STATE SURCHARGE SEWER& WATER 1.00 1 1401 COLJNTY ROAD 3 HOPKINS, MN TOTAL lO1.00 (952)938-4433 Payment(s) CREDIT CARD 6881 101.00 OWNER Wooddale Builders 6117 BLUE CIRCLE DR SU[TE 101 MINNETONKA, MN 55343- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable Ciry 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 sepazate permits. All 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 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 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 at any time for due cause. ! :,� . 1 ` / _�v �� ��� � ��� 1 I �� t {,�,�� � �� � ��, ��-- Applicant Permitee Signature Date Issued By Sig�i ture Date FO �TY USE ONLY 7 ���^/O Clty of OroIIo Date Received: t�er►nit# L �� � �� 'C� � P.O.Box 66 �1 2750 Kelley Parkway [,�In-House SAC Det�°°'�tion Form Completed � , Crystal Bay,MN 55323 _`�1 ' }'� .�j'l c� _�-��,�.,�s�( � �� ',;�� ��� (952)249-4600/Fax(952�249-4616 approved By(If Required): �J � CITY OF ORONO-SEWER& WATER/GENERAL PERMIT (*Note:Some permits may requirc approval by the Building Official and/or Public Works Departmcnt*) (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 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 �.ltesidential(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: � �I�Q � lA�������'��' ��� �,��'li �1��� S�t� m��l��� n ` � � ���� Owner: � �. ��� Mailing Address: f�`�� J�tle �iYt�(, �� ��l City: / '�1 ih I��,'�'b� ����� Zip: �7 5,���� Home Phone: -I Sa'��I� "U-S `I �� Alternate Phone: Contractor Information: Contractor: ��V��� � ��� ContactPerson: ���'' ��� Address: � �����( �� �� J State License#: �4� City: ���� Zip:S� �J Expiration Date: Phone: "l�S�� "I��1' CI��� AltematePhone: ���-�� t - �Ui7 DETERMINING PERMIT FEES ❑ SAC Charge(2015 Rate=$2,485.00) S (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 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 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 Pemut Fee&Issue Water Connecrion Permit 1. SUBTOTAL of Permit Requested: $ 2. STATE SURCHARGE $ 1.00 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 senarate permit. ■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon completion of ineter installation. 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"1 S-� ����� CONTRACTOR ���' � c � �C � DESCRIPTION ���`-�� � � l� ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING O ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL �CWATER HOOK-UP ❑ FOLLOW-UP _ ❑ AS BUILT-SURVEY ,,�SEWER HOOK-UP ❑ FOUNDATION/REMOVAL v ❑ DEMO-SITE ❑ TIC INSTALL 2 OWNERICONTNACTOR TO MEET YOU: YES_NO � COMMENTS: ��� .S�G.� SrC D[�� SCGUP�- �/`l�oc0� � �W/ �',�-�t'' '�u�� o �"/���s�/—��,��c����.�1�� � 0 � Q / � �l�'��� L _�in ��v uno � �v�r' K' - � T—� z �PJ"vi���—�+",n c�1- r.� � W � W � J W �fORKSATISFACTORY:PROCEED �ROJECT COMPIEfE � ❑CORRECT WORK&PROCEED O ISSUE CERTIFICATE OF OCCUPANCY W 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECWERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. �PHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED �INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-46�0 OwnerlContractor on site: �1 n l/_a Inspector. .�L'�'�� White Copyllnspector's File Canary CopylSfte Notice