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2013-00671 - sewer repair
� � " CITY OF ORONO 2750 KELLEY PARKWAY * 2 0 1 3 - PJ 0 6 7 1 * DATE ISSUED: 07/18/2013 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 3415 CRYSTAL BAY RD PIN : 17-117-23-43-0118 LEGAL DESC : WILEYS PARK LAKE MTKA : LO"1' 002 BC,OCK 001 PERMIT TYPE : SEWER PROPERTY TYPF. : RES[DENTIAL CONSTRUC"I'ION TYNE : REPAIR NO"I1�:: RI:PLnCI;A SI�:C�I�ION OI� PIPE-CLL:AN-OU�I� APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 BENJAMIN FRANKLIN PLUMBING STATE SURCHARGE SEWER& WATER 5.00 1424 3RD STREET N MINNEAPOLIS, MN 5541 I- TOTAL 55.00 (763) 755-6468 PAID WITH CC# 8985 OWNER ELSHAZLY, YOUSRY& KAREN 3415 CRYSTAL BAY RD WAYZATA, MN 55391- AGREEMENT AND SWORN STATEMENT Thc work for which this permit is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the State E3uilding 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 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 Yor a period of 180 days at any time afier work has commenced. The applicant is responsible ti�r assuring all required inspections are requestcd in conformance with the State Building Code.This permit may be revoked at any time for due cau �. �-.." _ ---'% ���- 7 � l� � l 3 c� � /� � , t Permitee Signature Date Issuc� y Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. t � ^ %`�`�- � F CI' Y�USI;ONLY,,, -7 i ��L I`/ City Of 01'On0 Date Received: Pem�it#D«�l - Q /� � �\ P.O.Box 66 � � 2750 Kelley Pazkti�ay ❑In-House SAC Determination Form Completed i ���y � �r' Crystal Say,MN�5323 � �`�����, t��,�' (952)249-4600 Approved By Qf Required): c�F�o , CITY OF ORONO - SEWER & WATER/ GENERAL PERMIT (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoplication is received) ''GENERAL INFORMATION 1. You may apply for utility permits by mail or in person at the Ciry offices. 2. Mailed in applications are subject to the postage and handlinb 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. ConCact 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 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: 3 Lt�s �r��sd*l �c�c/ /�� v - __ \ Owner: U(��'i'r�' ��,��i;z(Cf MailingAddress: 3�-(�� �r��� � �S'u� ��✓ City: V rU/t U Zip: -� J 3 �� Home Phone: �S� �7� �(�� � Alternate Phone: Contractor Information: � � �1�.,.���h� � � Contractor: �yt�crrr��� �n�['�,;� Contact Person: 0V pd� ���,� Address: �L/�`l ��� .S c� /�/ State License #: ��� � � City: ��� Zip: �S�l/ Expiration Date: � �� ��� � Phone: �G�"�`Y�� ��'6v Alternate Phone: S«�"'� � . � 1 �:� �- .: ; � � ,;:� � �ETERMINING PE�T=FE�� ` ' '',-° ❑ SAC Charge(2013 Rate=�2,435.00) $ (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 � v� 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 Department. Required Before Water Connection Permit is Issued: 1. Issue Water Meter& Horn Permit 2. Any Additional Connection Fees Paid(lf 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 Mai]-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 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 wark i� s17'ict,accor.danc� with the ordinar�ces of.th•e City and the regulations of the State of Minnesota, and certifies that all statements made on this application are,true and correct. _ o � _ _ Applicant: / � Date: .�^ � �� r 3 O"�� DATE TIME v CITY OF ORONO CALLED IN �'��'/3 INSPECTION NOTICE SCHEDULED 7! 8'—/3 //:� PE�iMIT NO�OI�,��1��7 1 MP�ETED ADDRESS OWNER TE HONE NO. /V4tf-� CONTRACTOR �� -a�s-�9�a >: DESCRIPTION � � ❑ 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. ❑ FOILOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO iF �� � COMMENTS: y � dJ(/C SC�i �� � ���/�J(r� W �� a � �. � O a � o � � 1 � � G � W � C�-S fi y « � Q � z � , � /g j v C �4'YI o v � � 5 c� a W ❑WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE � ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITNIN HOURS. ❑ pHOTOTAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CAII{NSPECTOR � INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in asivance. �95Z�4�-4600 OwnerlContractor on site: �� Inspector. White Copyllnspector's File Canary CopylSite Notice s� ` ��---� ✓ DATE /, TIME CITY OF ORONO CAL ED I�7-�( INSPECTION NOTICE SCHEDULED 7-30-�3 g:BU PERMIT NO.�D l.�j��d�I COMPLETED ADDRESS ���� � OWNER TEL�HO NO. ��v3 Z�`S 9(�'a CONTRACTOR �^^-�-^- N� >; DESCRIPTION ��'v � � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL Q ' ❑ 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 i ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOUT YES_NO � � COMMENTS: ��� LiA�P�/f�h/ a /A �� J � � J 0 o ��P�4rlg��� � W �/ ac `f Q � � ���s�- �N �1�� � � ���°� ��,��ev j �����1 0� / �� �� L�/I/C./+ � �y�(n �T � GW ❑WORKSATISFACTORY:PROCEED C� PROJECTCOMPLETE ��� � ❑CORRECT WORK&PROCEED Cl ISSUE CERTIFICATE OF OCCUPANCY W � ❑C�RRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR u CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. 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