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Home My WebLink About2010-00117 - sewer/water connection L } ' CITY OF ORONO PERMIT NO.: 2010-00117 2750 KELLEY PARKWAY ORONO, MN 55356- �ATE [SSUEu: 03/03/2010 952 249-4600 FAX: 952 249-4616 ADDRESS : 1785 CONCORDIA ST PIN : 17-117-23-22-0016 LEGAL DESC : COFFEES ADDN TO SHADY WOOD LAK : LOT 000 BLOCK 000 PERMIT TYPE : SEWER& WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION NO"I�E: CREDIT"I'O l3E ISSUED PGR CI IAR'I'(RD&BGS) APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 UP NORTH MECHANICAL WATER CONNECT/DISCONNECT/REPAIR 50.00 43900 ELMCREST AVE P.O. BOX 35 STATE SURCHARGE SEWER& WATER 0.50 HARRIS, MN 55032 S.A.C. 0.00 (651)277-0515 MISC FEE 0.00 TOTAL ]00.50 OWNER DULIN, KEVIN & BARBARA 1785 CONCORDIA ST WAYZATA, MN 55391- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable Cit�approvals,and the State Building Code. This permit is for only the work described and does not grant permission for additional ar related work which requires separatc permits. All provisions oflaws and ordinances governing this type ofwork shall be compied with�chether 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 requestec�i�conformance�vith the State Building Code.This permit may be rev �at any ti � _duc c�use. ��i' / l l �7YV�-Q'rL l l Appli t Permitee Signaturc Date [ssued E3y � nature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO r � FOR CITY L SE OtiLY City of Orono Date Received: Permit# r��,' P.O.Box 66 � � ' 2750 Kelley Parkway ❑In-House SAC Determination Form Completed J a si� * �' Crystal F3ay,MN 55323 �t� '�,. t o`,:� (952)249-4600 Approved[3y(If Required): >:i�awxos`-' CITY OF ORONO-SEWER& WATER/GENERAL PERMIT (*Note:Some permits may require approval by thc Building OfYicial and/or Public Works Department*) (AI.I.PERMITS- J1av be subicct to further review and mav not be issued when the anolication 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 AIYY h1A1N withoat 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 �vork must be inspected before it is covered. Call (952)249-4600,24+hour notice required. TYPE OF PERMIT Check All That A 1 � �esidential (May Require Approval) �Commercial (Approval Required) ❑ New Connection ❑Additional Connection �Re-Connection ❑ Repairs ❑ Disconnect ❑ Water Availability Con ction For Future Hook-Up to Water Job Site/Owner Information: Site Address: ��S ��/�'��l�-'-' �� % Owner: �2�/�`N (�� ,btJ � Mailing Address: City: ��-CS-,:��= �� Zip: Home Phone: Alternate Phone: Contractor Information: � �� Contractor: �1 �v--� �i.;� L�'y6 -,�/��n act Person: � ---�i�� Address: � � ` - � �- , ,�c��x�� State License#: ��G � City: ��i^i �S Zip:_�,��cpiration Date: �� Phone: Alternate Phone: — -; � . ` DETERMINING PERMIT FEES ❑SAC Charge(2010 Rate=$2,100.00) $ (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 Connection/Disconnect/Repair($50.00/Per Stub) $ Pipe size inches;materia] Schd 40 air tested; cast iron ❑Water Connection/Disconnect/Repair($50.00/Per Stab) $ 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 [ssued: 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: $ 2. STATE SURCHARGE $ .50 3. POSTAGE R 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 Gity of Orono far issuance of a Utility Pennit, agrees to do all work in strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and certi�es that all statements made on this application are, true and correct. Applicant: Date: Reset Form �g � DATE TIME � CITY OF ORONO CALLED IN �'Z _ INSPECTION NOTICE SCHEDULED .S- /D •�DO PERMIT NO. �0/d - bD//7 COMPLETED ADDRESS �7a 5 W,��-�a �l OWNER `��. TELEPHONE NO. - CONTRACTOR �`�' �v7� � '�� : DESCRIPTION llQ�i(. Y' U/Q� � � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL O ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT J ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP ? ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARO COVER REMOVAL � ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W a o �, �� -i- c.� � �o�� ° ,� T� t C�� _� SG�.,�.� �1��. � � � � �� Q � ��` S�'�� `�vQ z W � W � � d KSATISFACTORY:PROCEED O PROJECTCOMPLETE � ❑CORRECT WORK&PROCEED � ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT �CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pHOTOTAKEN INSPECTOR WILL RETURN ❑ CITATION ISSUED ❑STOP ORDER POSTED.CAIL{NSPECTOR ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �Q52� 249-46�� OwnerlContractor on sit .i Inspector. � White Copyllnspector's File Canary Copy/Site Notice �^ � D E TIME � CITY OF ORONO CALLED IN �o / �a INSPECTION NOTICE /y� SCHEDULED ///o ��'J. PERMITNO.o�la�w,�� OMPLETED ADDRESS g � � OWNER TEL_EP/HIONE NO.�'" �_�$S� 'Z' CONTRACTOR WF� �� C�` ' �: DESCRIPTION ��'��J"'� — � � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/G ING/FILLING Q ❑ POURED WALL ❑ MECHANICAL AI ❑ LAKESHORE/WETL4NDS y ❑ FRAMING ❑ MECHANICAL FINAL O ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL �SEWER HOOK-UP ❑ COMPLAINT J ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL � ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W C a � 1 �j�� r S��r t �� c� iL � � � ( .�1 A �-eT ��? E�z.c C� rL. W ' � Q ti Z W � W � � d WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE � ❑ RRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALI FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT �CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN �NSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑ INSPECTION REQUIRED.CALI TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952� 249-4600 Owner/Contractor on site: Inspector. '/c_)� J White Copyllnspector's File Canary CopylSite Notice