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Home My WebLink About2012-00760 - sewer disconnect CITY OF ORONO * z 0 1 z - 0 0 7 6 0 * , 2750 KELLEY PARKWAY DATE ISSUED: 08/06/2012 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 325 CRESTVIEW AVE P[N : OS-117-23-14-0031 LEGAL DESC : BAYS[DE ADDN TO LAKE MINNETONK : LOT 000 BLOCK 005 PERMIT TYPE : SEWER PROPERTY TYPE : RES[DENT[AL CONSTRUCTION TYPE : DISCONNECTION APPL[CANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 WESTONKA SEWER& WATER STATE SURCHARGE SEWER& WATER 5.00 6501 CO. RD 15 TOTAL 55.00 MOUND, MN 55364 (952)472-4959 Minnesota State License#: 1804 OWNER SULL[VAN, WENDY 3409 26TH. AVE. S MINNEAPOLIS, MN 55406- AGREEMENT AND SWORN STATEMENT I hc work for which this pern�it 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 perniission Cor additional or rclated work which requires separate pennits. All provisions of laws and ordinances governing this type of wark shali 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 a[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. �P� CZ' � � l l Applicant Permitee Signature Date Issued Qy Signature Datc SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. r , CITY OF ORONO * z 0 1 z — B 0 7 6 0 * ' , 2750 KELLEY PARKWAY DATE ISSUED: 08/06/2012 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 325 CRESTVIEW AVE PIN : OS-117-23-14-0031 LEGAL DESC : BAYSIDE ADDN TO LAKE MINNETONK : LOT 000 BLOCK 005 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : D[SCONNECTION APPL[CANT SEWER CONNECT/D[SCONNECT/REPAIR 50.00 WESTONKA SEWER& WATER STATE SURCHARGE SEWER& WATER 5.00 6501 CO. RD 15 MOUND, MN 55364 - -��"' �9s2�4�2-4as9 TOTaL s�.00 Minnesota State License#: 1804 OWNER SULLIVAN, WENDY 3409 26TH.AVE. S M[NNEAPOLIS, MN 55406- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specitications,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 not specitied herein.This pennit 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 wi[h the State Building Code.This permit may be revoked aY any time�� ..-- ,� - , ,% �--_....�_.� / - / �.� (.C/t't--�' / / pplicant Permitee Signature Date lssucd I3y � nature Date SEPARATE PERMITS REQU[RED FOR WORK OTHER HAN DESCR[BED AB . r . � � FOR CITY USE ONLY 4�,�` Clty Of�COno Date Received: Permit# `r P.O.Box 66 �"� � 2750 Kelley Parkway ��; ❑In-House SAC Determination Form Completed a 1�'��r,. � Crystal Bay,MN 55323 � �d��y��'��;�.�o` (952)249-4600 �Approved By(If Required): CITY OF ORONO— SEWER & WATER/ GENERAL PERMIT (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) (ALL PF,RMITS- Mav be subiect to further review and mav not be issued when the application is received) GENERAL INFORMATION 1. You may apply for utility permits by mai] or in person at the City offices. 2. Mailed in applications are subject to the postage and handling fee shown below. Perniit 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 pemut card is available on the job site. 5. Utility connection pernuts may be issued to licensed contractors only. 6. Contact the Public Works Deparrinent(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 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: �� 5��..� �v� • Owner: Mailing Address: City: Zip: Home Phone: Alternate Phone: Contractor Information: , '��!� G� Contractor: ��-�'��G��G ��'� �'`�Contact Person: �Fi 4�'� C�c i�� / Address: �5�� S� State License#: City: j��*�� `" Zip:s��' T Expiration Date: Phone: C��-�-( ?-Z-�(S,b� Alternate Phone: �'�� 7y�- �7�cT C C�� ' � • . _ _, � � ��',. � a:� r� �� DBTERMINING PERMIT FEES �� i ❑ SAC Charge(2012 Rate=$2,365.00) $ (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) g] Sewer Conn ion�/Disconnec epair($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 Exulanation: 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: L 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 1-3 Above) $ � ADDITIONAL INFORMATION—WATER METERS ' ■ WATER METERS must be picked up and paid for at Orono City Hall, these are on a s�arate pernut. ■ 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 stateme ts ade n this application are, true and correct. �J �� - — A lican • �� -� pP t• Date: � � DAT TIME ✓ CITY OF ORONO CALLED IN � � INSPECTION NOTICE SCHEDULED Z /D � D PERMIT N0. ��l a 'dd 7� MPLETED ADDRESS � Jv� ��-�T�"l/1�LC� L��L%�_ OWNER G�Y(�LCGL �NEI/V �!�-7 ��-�'j 77� CONTRACTOR N ) >; DESCRIPTION ��- ��`S � � ❑ 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 J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: y�� SC/� �/D ��i/.�YJe�/ 9 ��_ a 13/�c,f�.� � � � O >. � ° —�T !r/0/'T W � Q ti ' � 5`�`�r W � � a res �i� W� �WORKSATISFACTORY: ❑ PROJECTCOMPLETE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑ CORRECT WORK,CAIL FOR REINSPECTION TEMPORARY � BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED O INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. �95Z� Z49-4600 OwnerlContractor on site: �'�'5�� Sw!'a �t1�"r Inspector. 5�4� White Copyllnspector's File Canary Copy/Site Notice