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2014-01085 - sewer/water disconnect
�ti ` CITY OF ORONO * Z 0 1 4 — 0 1 0 8 5 * 27_50 KELLEY PARKWAY DATE ISSUED: 09/23/2014 ORONO, MN 55356- (9�2) 249-4600 FAX: (952) 249-4616 ADDRESS : 3309 CRYSTAL BAY RD PIN ; 17-117-23-41-0016 LEGAL DESC : WALLACES ADDN TO VIL OF MTKA B : LOT 001 BLOCK 000 PERMIT TYPE : SEWER& WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION NOTE: SEWI;R& w'ATGR DISCONNECT APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 WATER CONNECT/DISCONNECT/REPAIR 50.00 D.S.M. EXCAVATING STATE SURCHARGE SEWER&WATER 5.00 2916 ENTERPRISE AVE HASTINGS. MN 55033- TOTAL 105.00 (651)480-1355 Payment(s) CREDIT CARD 0444 105.00 OWNER SCHMID, DAVID 3309 CRYSTAL BAY RD WAYZATA, MN 55391- AGREEMENT AND SWORN STATEMF,NT The work for which this pennit 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 granf permission for additional or related work which requires separate permits. All provisions of laws and ordinances governin�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 eommenced within 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any time atter work has commenced. The applicant is responsible for assuring all required inspections are requcsted in conformance with the State Building Code.This permit may be revoked at an}�time for due cause. � , � � Q_ �3., � y�. , �-3 , � Applicant Permitee Signature � Date [ssued By Signature Date , . . FOR C1TY USE ONL,Y .�� �y j'`� ���C'—''- �r-� Clt3'of Orono Date Received: Pemut# ���\ P.O.Box 66 !, ��, � 2750 ICelley Parkway ❑In-House SAC Determination Form Completed ;.-`�� ' .�1 Crystal Bay,MN 55323 ��� ' '�'1. -f� (952)249-4600/Fax(952)249-4616 Approved By(If Required): 't.�;,��,�. CITY OF ORONO- SEWER& WATER/ GENERAL PERMIT (*!\ote:Some permiu may require approval by the Building Official andlor Public Works Department*) (ALL PERMITS- Ma� be subiect to further review and mac not be issued when the application is received) 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 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 MAIl\`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) ❑ 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: 3��� �7�9L��y �¢� Owner: �ilil „�LrTZ- Mailing Address: city: O�D�s/D zip: Home Phone: Alternate Phone: Contractor Information: Contractor: ,�S , t��iS��N,b��vGContact Person: /l/i�c'� ��/���✓� � Address: Z"/� �i1fi�'-�'�/S+�f� , State License#: City: �Nbs Zip:�� Expiration Date: Phone: �m5/- �g0 •/35�� Alternate Phone: lG/Z �/9�`��y� f � t DETERMINING PERMIT FEES ❑ SAC Charge(2014 Rate=$2,485.00) $ (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) lX►Sewer Coonectio /Disconnect/ epair(�50.00/Per Stub) $ T� Pipe size inc es;matenal Schd 40 air tested; cast iron �f Water Connectio Disconnect Repair($50.00/Per Stub) $ Pipe size inc es;matenal Schd 40 air tested; copper ❑Water Availability For Future Hook-Up to Water($50.00) $ Water Availabiliri�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&Hom 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 PERMTT FEE(Add Lines 1-3 Above) $ ADDITIONAL 1NFORMATION-WATER METERS ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate�ermit. ■ 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, a�rees 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 statements made on this application are, true and correct. 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'!' , 4�, t .... _ fe k✓ ... .i a�� �b «`,"��� � � � $ .���.��� . ��`-�� � '�*� �'�..,.� . �' � �_�rD,QIEI� TIM� CITY OF ORONO CALLED IN I G� Z�' INSPECTION�VIQT�C�' f\`�S SCHEDULED � , � PERMIT NO. d-ix '�� COMPLETED ADDRESS � OWNER TELEPHONE NO.�� � ����� CONTRACTOR ��� �-X� � �'�` �� �; DESCRIPTION S � �' ��S C.U��-k` � ll� ❑ FOOTING O PLUMBING FINAL ❑ EXCAV/GRADING/FILLING � ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORFJWETLANDS � O ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNERlFIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT r ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI O SEPTIC FINAL ❑ FOUNDATION/REMOVAL 2 OWNERICONTRACTOR TO MEET YOU:_YES_NO / � � COMMENTS: ���'��1'a� W�� �i SCt�1�/I e�fi � W a o �� � D �. � 0 � W � Q � 2 W � W � J W ❑WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLEfE � ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN INSPECTOR WILL REfURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Cail for the next inspection 24 hours in advance. (952� 249-4600 OwnerlContractor on site: �� ��� Inspector. �f�� White Copyllnspector's File Canary CopyfSite Notice