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Home My WebLink About2016-00357 - sewer disconnection � CITY OF ORONO * 2 PJ 1 6 - 0 0 3 5 7 * 2750 KELLEY PARKWAY DATE ISSUED: 04/11/2016 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 1220 BRACKETTS POINT RD pIN : 11-117-23-32-0018 LEGAL DESC : RGT ORONO POINT : LOT 000 BLOCK 000 PERM[T TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION NOTE: SEWER DISCONNECT APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER&WATER 1.00 COPPIN SEWER&WATER TOTAL 51.00 864 QUAIL PKWY Payment(s) WATERTOWN,MN 55388- CHECK 4843 51.00 (612)508-9974 Minnesota State License#: SW-57329MR OWNER HANNAFORD,JULE&ELIZABETH 1220 BRACKETTS PT RD 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 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 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. ---- -- -------_. " ' `f`��.- � "1 l%;. -�-,e � �'z '�j < � i �-t, ,,.. Applicant Permite ignature Date Issued B gnature Date . , FOIt CITY USE ONLYr - /��0� City of Orono Date Received: �/!o Pernrit# � �s� r i P.O.Box 66 � 2750 Kelley Parkway ❑In-House SAC Determina6on Form Completed �s� �-f Crystal Bay,MN 55323 \\,�A c s�i�4�.�� (952)249-4600/F�(952)249-4616 Approved By(I�'Required): �� U J CITY OF ORONO-SEWER& WATER/GENERAL PERMIT (*Note:Some permits may require approvai by the Buiiding Official and/or Public Works Departrnent•) (ALL PERMIT'S- Mav be subiect to further review and mav not be issued whea the anulication is receivedl GENERAL INFORMATION 1. You may apply for utility permits by mail or in person at the City offices. 2. Mailed in applicarions are subject to the postage and handling fee shown below. Pernvt 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. Urility 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 ANI'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 �Disco�ect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner info�afion: Site Address: 1 �.�.L (�,;' c� , tc� �� , ('e� � �- �'� t� Owner: �'u �F '�4��t�,Fc��a MailingAddress: �� r, �r��►��.�1-�, ��,;�� Rp City: �`l C-'�`� � �} Zip: ��3"�� Home Phone: Alternate Phone: Contractor Information: Contractor: C T�� S c� ,,,;�� ,,,�,,�� Contact Person: �` ��-� Address: �� o.��,,� ��;,,� State License #: � ")��q • ,�.�� City: 1�lv;�e��c� Zip�� Expiration Date: \�, - 3\� \(� Phone: �\a-S G�-`1"1�`� Alternate Phone: . . DETER.MINTN�PERMIT FEES ❑ SAC Charge(2015 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) �Sewer Connection(/Disconnec Repair($50.00/Per Stub) $ Pipe size inche , a erial Schd 40 air tested; cast iron ❑ Water Connection/Disconnect/Repair(550.00/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: ]. 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 I. 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 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 ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements made on this application are,true and correct. Applicant: �' � Date: �—�� - � (; ./� �� / DATE TIME i..' ITY OF ORONO CALLED IN -/��"�` --�� INSPECTION NOTICE SCHEDULED ' PERMIT NO.,��E�� "�'`��`��COMPLETED ADDRESS I ��- �� 1 ��C �I '�S OWNER TELEP NE NO.�P�a Sb$" �g�7� CONTRACTOR � DESCRIPTION ��-'�J'�� 1 c��=�� lL ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING Q ❑ FOUNDATION WATERPROOF ❑ PIUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP �U ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL _ v ❑ DEMO-SITE ❑ TIC INSTALL 2 OWNERfCONTRACTOR TO MEET YOU:�YES_NO y COMMENTS: � W a O `��/ � , ). � O � W � Q � 2 W � W � ��Ll WORKSATISFACTORY:PROCEED �PROJECT COMPLETE W ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS_ p pHOTO TAKEN INSPECTOR WFLL REfURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Cail for the next inspection 24 hours in advance. (952� 249-46�0 OwnerlContractor on site: �">> �% ��i.'i�!'��`� � Inspector. �'^'� White Copyllnspector's File Cenary CopylSite Notice