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HomeMy WebLinkAbout2014-00154 - sewer/water connect � CITY OF ORONO * z 0 1 4 - 0 0 1 5 4 * 2750 KELLEY PARKWAY DATE ISSUED: 02/25/2014 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 105 CREEK RIDGE PASS PIN : 03-117-23-12-0012 LEGAL DESC : CREEKSIDE IN ORONO : LOT 001 BLOCK 001 PERMIT TYPE : SEWER& WATER PROPERTY TYPE : RESIDENT[AL CONSTRUCTION TYPE : CONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 WATER CONNECT/DISCONNECT/REPAIR 50.00 BURNS EXCAVATING, INC. STATE SURCHARGE SEWER& WATER 5.00 3470 CO. RD 21 MAYER, MN 55360- TOTAL 105.00 (612)685-4303 Payment(s) Minnesota State License#: SW-1888 CHECK 25092 105.00 OWNER Hometime Video Publishing Inc 4355 PEAVEY RD CHASKA, MN 55318- AGREEMENT AND SWORN STATEMENT I�he work for which this permit is issued shall be performed according to the approved plans and specifications,applicable City approvals,and thc 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 issuancc,or if construction is suspended for a period of 180 days at any time af[er work has commenced. The applicant is responsible for assuring all required inspec[ions are requested in conformance with[he State Building Code.This permit may be revoked at any[ime for due cause. il —__ � / / Applicant Permitee Signaturc Date [ssucd By Si ture DaCe t � �" • FO C7R/ 1'j'Y�JSE ONLY OI 7 'D �'S� �����%�,�r Clty o1��1'oRo Date Received:�-���� Permit N � \� P.O.Bux 66 ~ �� 1� 2750 Kelley Parkway ❑In-House SAC Detenninatiou Form Completed {, \ � � Crystal Bay.MN 553�3 �� ��^� � j (952)249-4600/F�x(952)249-4616 Approved By(If Required): CiTY OF ORONO-SEWER & WATER/ GENERAL PERMIT (*Vote:Some permits may reqiiirc approval by the Building Official nnd/or Public Works Department*) (ALL PERM11'S- Mav he subiect to further rcview and mav not be issued H'hen the apnlication is received) GENERAL 1NFORMATION l. You may apply for utility permits by mail or in person at tl�e City offices. 2. Mailed in applications are subject to the postage and handling fee shown below. Permit cards will be sent by retum inail within 2 business days. 3. Permits are not valid until you receive a permit card. 4. Work must not begin unless tl-,e permit card is available on t1�e job site. �. Utility connection pernlits may be issued to ticensed 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 MA1N without express approval of the Public Works Department. Issuauce of a permit does not grant this approval. 7. All work must be done in accordance with State Code reqtiirements. 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: �G�`� G%�E:�l� .�Z /l7� �f94� Owner:.- �ti/�iV d!"'i�t,l�.�tv:��b1�//U Mailing Address: I Z�� f-l�/i/'�T�'ti��1=��G'Z; City: ���I_ 3"-u�h!�L- Zip: ��3 5�1 Home Phone: �- Alternate Phone: ( Contractor Information: Contractor: �,(,l2itl5 �5��'I�,ifl�71�2;G� Contact Person: S�l�-�l L �C•L,�/L15 Address: �z-(7L,� �'L�L/,�1,�%Zl-�Z j State License #: - "-_lZ City: � Zip: `��� Expiration Date: Phone: �C1SZ GI���l/Z Alternate Phone: ��d%?� �KS'L/.��.3 r ' DETERMINING PERMIT FEES ❑SAC Charge(2014 Rate=$2,485.00) $ (SAC Chaige must accompauy all scwer permit applications imless prepaid) (Orouo 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; n�aterial Schd 40 air tested; cast iron [�Water Connection/Disconnect/Repair($50.00/Per Stub) $ Pipe size inchcs; material Scl�d 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 Pennit is Issued: 1. Issue Water Meter&Honi Pernut 2. Any Additional Connectio�i Fees Paid(If Applicable) Issue Water Connection Permir. 1. Collect Permit Fee&Issue Water Connection Permit 1. SUBTOTAL of Permit Requested: � 2. STATE SURCHARGE $ 5.00 3. POSTAGE&HANDLWG(Only on Mail-In Applications) � 2.��� 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ ADDITIONAL INFORMATION—WATER METERS ■ WATER METERS u�ust be picked up ancl paid for at Orono City Hall,these are on a separate pennit. ■ W'ATER METERS must be set and sealed by Orono Watcr Department (952) 249-46U0, 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 ardinances of the City and the regulations of the State of Minnesota, and certifies that all statements made on this application are, true and con�ect. 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INSPECTION�O�T� ��D/S��CHEDULED _�� � PERMIT NO. �rCOMPLETED ADDRESS ��S ���-' /�'�YrC-� ll'"��J OWNER TELEPHONE NO.��Z �1�ScS����Z CONTRACTOR �� . � DESCRIPTION UE�i��(.�/��(, � � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICALFI ❑ LAKESHORENVEfLANDS y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB �WATER HOOK-UP ❑ PROGRESS � ❑ FINAL �SEWER HOOK-UP ❑ COMPLAINT � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO c�., COMMENTS: � W a � J O �. � O � W � Q � . , 2 W � W � J d W� ❑WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE � ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pH0T0 TAKEN INSPECTOR WILL REfURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (g52) 249-460� OwnerlContractor on site: Inspector. �6ri-ab • White Copyllnspector's File Canary CopylSite Notice