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Home My WebLink About2011-00439 - sewer/water connect CITY OF ORONO PERMIT NO.: 2011-00439 -. 2750 KELLEY PARKWAY ' ORONO, MN 5535G- DATE ISSUED: 06/08/2011 952 249-4600 FAX: 952 249-4616 ADDRESS : 115 CREEK RIDGE PASS PIN : 03-117-23-12-0013 LEGAL DESC : CREEKSIDE IN ORONO : LOT 002 BLOCK 001 PERMIT TYPE : SEWER& WATER PROPERTY TYPE : RES[DENTIAL CONSTRUCTIOI�I TYPE : CONNECTION NOTE: SAC PA[D W[TH BUILDING YERMIT 20 1 1-003 1 8 APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 BURNS EXCAVAT[NG, INC. 3470 CO. RD 21 WATER CONNECT/DISCONNECT/REPAIR 50.00 MAYER, MN 55360- STATE SURCHARGE SEWER&WATER 5.00 (612)685-4303 MAIL-IN FEE 2.00 Minnesota State License#: 1888 TOTAL 107.00 OWNER PFEIFER,ANDY&MARNIE 115 CREEK RIDGE PASS LONG LAKE,MN 55356- AGREEMENT AND SWORN STATEMEIYT 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 governing this type of work shall be compied with whether or no[speciYied herein.This permit will �expire and become null and void if construction au[horized is not commenced wi[hin 180 days of the date of issuance,or if construction is suspended for a period of I 80 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. l_`��`�"'�,,,�(, ", � � � / / Applicant Permitee Signature Date Issued y S� ature at SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCR[BED A O . • � ' P'OR CITY USE O�`LY City of OrOno Date Received� Permit i� � ��"�'� P.O.Box 66 � �� 27�0 Kelley Parkway ❑In-House SAC Detennination Form Completed ,� i"� �.�' Crystal Bay,MN 55323 A roved B If Re uired�� `a+ �� 8`� (952)249-4600 pP Y( 9 )� ��exabso�4% CITY OF ORONO—SEWER& WATER/GENERAL PERMIT ('"Note:Some permits may require approval by the Building Ofl�icial and/or Public Works Department*) (ALI PFRNIITS- Mav be subiect to further review And mav not be issued when the aonlication is received) GENERAL INFORMATION L 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 ) �Residential (May Require Approval) ❑ Conunercial(Approval Required) [�f New Connection ❑ Additional Connection ❑ Re-Connection ❑ Repairs ❑Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address: � I� �l�� t�� (C/�� I�S S Owner:��IC�12' .—�Lc )��E F F��Z Mailing Address: ,��I D Z �� ti'�-� ��-= �� Citv: ��ItIMbL«"1+ Zip: SS�/�ICO - ---r Home Phone: Alternate Phone: Contractor Information: Contractor: �L.(.Izi�ia ��ll_'�Vl977P�, Contact Person: S 1��%L�� t.�N�- T�tt:� /�� S E=(�?"c L Address: ��17U CD IZC_I Z l State License#: f'1"��=- �vt';� �" �OD3 — Z�� City: M Zip:��P��Expiration Date: l�`'1i`I,PC'�ff ZGIZ Phone: ��SZ� �� -3/!1� Alternate Phone: ��Dl��. �SS � '��d� , - • . t DETERMINING PERMIT FEES ❑ SAC Charge(2011 Rate=$2,230.00) $ (SAC Cliarge must accompany all sewer permit applications unless prepaid) (Orono City Staff can determine if applicable) ([f 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 Availability 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 Permit Fee& Issue Water Connection Permit 1. SUBTOTAL of Permit Requested: $ 2. STATE SURCHARGE $ 5.00 3. POSTAGE&HANDLING (Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines l-3 Above) $ ADDITIONAL INFORMATION —VS�AT�:R MET�RS ■ 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 Pennit, 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 state�nents made on this application are, tr�ie and correct. Applicant Date: ��/ j �DA TIME � CITY OF ORONO CALLED IN � INSPECTION NOTICE SCHEDULED %OI� PERMIT NO. ��dG�-3 COMPLETED ADDRESS OWNER TELEPHO E NO.75Z�g�S—�`/� CONTRACTOR Ll/�D �; DESCRIPTION L(J� � 0��%�� ❑ 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 � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP � ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: �b I � —�n h� o � � s ��'S r" �'` ( � � � ' '� •-f U `� �� S + <_ 't� 7 i r'S S � � i Z t'C� W o� , Q - � � z � '� � I�✓�� ,1 �--v' W o_— � � ��:r1+L; 12,Scr � d . W�,�'�ORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W ❑CORRECT WORK&PROCEED '= ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pH0T0 TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED G INSPECTION REQUIRED.CAIL TO ARRANGE ACCESS. Call forthe next inspection 24 hours in advance. �95Z� Z49-460� Owner/Contractor on site: Inspector. . f r/ /�-� White Copyllnspector's File Canary CopylSite Notice