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Home My WebLink About2009-0068 - sewer/water connect CITY OF ORONO PERMIT NO.: 2009-oo6s9 � � 2750 KELLEY PARKWAY ORONO, MN 55356- DA7'E [ssuEu: 10/09/2009 952 249-4600 FAX: 952 249-4616 ADDRESS : 110 CREEK RIDGE PASS PIN : 03-117-23-12-0015 LEGAL DESC : CREEKSIDE IN ORONO : LOT 004 BLOCK 001 PERM[T TYPE : SEWER& WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION NOTF.: SAC COLLECTED WITH BUILDING PERMI"1�2009-00475 APPLICANT SEWER CONNECT/D[SCONNECT/REPA[R 50.00 UP NORTH MECHANICAL STATE SURCHARGE FLAT-OTHER 0.50 43900 ELMCREST AVE P.O. BOX 35 TOTAL 50.50 HARRIS, MN 55032 (65 I)277-0515 OWNER JOHNSON, ANDREW 4215 TRILLIUM LN E MOUND, MN 55364- 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 gran[permission for addi[ional or related work which requires separate permits. All provisions of laws and ordinances governing 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. 'rhe applicant is responsible for assuring all required inspections are reques[ed in conformance with the State Building Code.This permit may be rev ke ny time for due cause. i j C '� , C� / / ' nt Permitee ignature Date Issued By Si n ture te SEPARATE PERMITS REQUIRED FOR WORK OTHER AN DESCRIBED ABO FOR CITY USE ONLY 0,��,�`O CitV of Orono Date Received: Permit# `r P.O.Box 66 �F,��ti,,, 2750 Kelley Parkway ❑In-House SAC Determination Form Completed .� Ij ?, �; � Crystal Bay,MN 55323 ��g�-yo (952)249-4600 Approved By(If Required): e CITY OF ORONO -SEWER & WATER/ GENERAL PERMIT (*Note:Some permits may rcquire approval by the Building Official and/or Public R%orks Department*) (ALL PERMITS- Ma�•be subicct to further revien�and mav not be issued when the application is reccived) 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 mai] within 2 business days. 3. Permits are not valid until vou receive a permit card. 4. Work must not begin unless the permit card is available on the job site. 5. Utility connection pernuts 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 pernut 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 Apply) ❑ 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� ��'�C �/�S `� Owner: `�� a��; Mailing Address: `f.�S,S- /�6.�4-✓E v �'c1�- City: � Zip: .S�/ UE:�-� Home Phone: � Alternate Phone: �,S`Z - z� � `- ✓�Y�j Contractor Information: ;%� /� Contractor: --� � ��J �� o�ct Person: �� %�/�� ,��/J�. ��'' -�,�,=��/�%� �'p `�` Address: �� State License #: �� -�4'j�/ City: ip: Expiration Date: �-�� `�_,./ .T--- � Phone: �-�J�-�/�� Alternate Phone: /o` C% �Y� ��! DETERMINING PERMIT FEES � � ❑ SAC Charge(2009 Rate=$2,000.00) $ (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/R pair(�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 Deparhnent. Required Before Water Connection Permit is Issued: 1. Issue Water Meter&Horn Permit 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Connecrion Permit: 1. Collect Permit Fee&Issue Water Connection Permit 1. SUBTOTAL of Permit Requested: $ 2. STATE SURCHARGE $ .50 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 b�� 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 ertifies that all statements made on this application are,true and correct. � � .' Applican . Date: � � � DAT(� TIME � CITY OF ORONO CALLED IN ��I / INSPECTION NOTICE SCHEDUL�� `•� PERMIT NO.��DU��9 COMPLETED ADDRESS C%�� , OWNER NTR. TELEPHONE N0. �0�?�► ip � � DESCRIPTION ��1�.G�}^Bl.� �� DYL. � ❑ FOOTING ❑ MECHANICAL RI ❑ EXCAV/GRADWG/FILLING Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETLANDS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE Q ❑ TREE REMOVAL Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT � ❑ DEMO-FINAL C'1RJ TALL. ❑ FOLLOW-UP i ❑ PLU ❑ SEPTIC FIN L ❑ HARD COVER REMOVAL J ❑ PLU BING FINAL ❑ FOU D TP�I�fJ/�MOVAL � OWNER CONTRACTOR TO MEET YOU:_YES NO �/`�V � ��,�` �� COM ENTS: u I2`�''• � � �� Q�� J O �>. � O �I.� • � ti � Q � ��Z � r�C t �\� t��• '� � � � p �� Q � � � �� d W� j�WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE W � ❑GORRECT WORK&PROCEED C ISSUE CERTIFICATE OF OCCUPANCY 0 G CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN INSPECTOR WILL RETURN �STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Ca11 forthe next inspection 24 hours in advance. (952) 249-460� OwnerlContractor on sit�_��T.a 3f Inspector. � White Copyllnspector's File Canary CopylSite Notice