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Home My WebLink About2011-00190 - sewer/water connect .s. CITY OF ORONO PERMIT NO.: 2011-00190 2750 KELLEY PARKWAY � ORONO, MN 55356- DATE �SSUED: 03/3U2011 952 249-4600 FAX: 952 249-4616 ADDRESS : l20 CREEK RIDGE PASS PIN : 03-]17-23-12-0014 � LEGAL DESC : CREEKSIDE IN ORONO : LOT 003 BLOCK 001 � PERMIT TYPE : SEWER& WATER I NROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION . APPLICANT SEWER CONNECT/DISCONNECT/REPA[R 50.00 NEUTGENS EXCAVATING �,CONSTRUCTION WATER CONNECT/D[SCONNECT/REPAIR 50.00 16230 54TH ST ST MICHAEL, MN 55376- STATE SURCHARGE SEWER& WATER 5.00 TOTAL 105.00 OWNER GUSTAFSON, MICHAEL& SUSAN 1000 SHELARD PKWY#300 MINNEAPOLIS, MN 55426- � AGREEMENT AND SWORN STATEMENT �I�he��ork for��hich Uiis permit is issucd shall be performed according to the approved plans and specifications,applicable City approvals.and the State[3uilding Code. This permit is for only the work described and docs not grant permission for additional or rclated work�vhich requires separate permits. nll provisions of laws and ordinanccs ooverninc this typc of work shall be compicd with whether or not speciticd herein.'I'his permit will expirc and bccomu null and void if construction authorized is not � commenced within I80 days of the date of issuance,or if construction is suspended lor a period of I 80 days at any time after work has commenced. Thc 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 e cause. -�� / / � A plicant Permitec Si�natin�c Date Issued B��Si ure � Date SEPARATE PERMITS REQUIRED FOR WORK OTHER AN DESCRIBED A OVE. FOR CITY USE ONI.Y �" �� CItV Of�POOO Da[e Received: Pennit# / ��'��\ P.O.[3ox 66 ��; �'� 2750 Kelley Parkway ❑In-House SAC Detennination Form Completed �i�} �f1�` • �i� Crystal Bay,MN 55323 R-; '�� r�o`� (953)349-4G00 Approved I3y(If Required): �:�°drexo�$.� CITY OF ORONO—SEWER& WATER/ GENERAL PERMIT ("`Notc Soine peiniits may rcquire approval by the 13uilding Official and/rn Public�'Jorks Department*) (ALL NH:R�II'1'S- '�1a��be subiect to further revie�v and ma��not be issued when the apn��cation is received) GENERAL INFORMATION 1. You may apply for utility permits by mail ar 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 withii�2 business days. 3. Permits are not valid w�til you receive a permit card. 4. Worl<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. [ssuance of a permit does not grant this approval. 7. All ��ork 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 ) ❑ 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: ,��/'�i'��p%� �'a/aG Site Address: '�' 'J �d''��—%�/ ` _ �� Z ��--e.�.� Owner: f,%�5��<�' �rJi1�� Mailing Address: Gity: Zip: Home Phone: Alternate Phone: Contractor Information: � '� � ��C��`f.-� Contractor: �u- ��rS L'.r� Gontact Person: �l Address: llv�.��/ .�� -STJ'�� State License #: �y �� City: � i li' Zip;��Expiration Date: ��✓'�� Phone: ��,�'�l�� Alternate Phone: �1�� a DETERMINING PERMIT FEES ❑ SAC Charge(2017 Rate=$2,230.00) $ (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;material Schd 40 air tested; cast iron Water Connection/ Disconnect/Repair($50.00/Per Stub) $ Pipe size inches;material Schd 40 air tested; copper ❑ ��ater Availability For Future Hook-Up to Water(550.00) $ Water Availabilih' Explanation: Contractor installed line to inside of house for future hook-up. This]ine will be inspected by the Public Works Department. Required Before Water Connection Permit is Issued: 1. �ssue Water Meter& Horn Permit 2. Any Additional Connection Fees Paid(If Applicable) ]ssue Water Connection Permit: 1. Collect Permit Fee&]ssue Water Connection Permit 1. SUBTOTAL of Pei7nit Requested: $ 2. STATE SURCHARGE $ 5.00 3. POSTAGE&HANDLWG (Only on Mail-[n Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ADDITIONAL INFORMATION— WATER METERS ■ �VATER 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. Tl�e 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 tlle City and the regulations of the State of Minnesota, and certifies that all statements made on t�application are, true and correct. ` �' �� .— / 7 � �� ` / Applicant: �� Date: L � // G�' D E TIME � CITY OF ORONO CALLED 1N ' � INSPECTION NOTICE a SCHEDULED - - � PERMIT NO. �D�I" UD I-( DCOMPLETED ADDRESS � � C�� P�. l r"��d� OWNER TELEPHONE NO� �Z -2g 2-S�3 CONTRACTOR ��Lt,� �� : DESCRIPTION �E��L ��5�� L � � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS � ❑ 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 v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS:_� U%�-�'� �� ti`� W 0. � � � � f i� '� �, l� 't. � O j� � � � � :C �1 � Q � � i Z W � W � � d W�WORK SATISFACTORY:PROCEED f.7 PROJECT COMPLETE � ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W 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 ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �952� 2Q9-46�� OwnerlContractor on site: � Inspector. W �L� �� S White Copy/lnspector's File Canary CopylSite Notice