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Home My WebLink About2015-00132 - sewer disconnect , . CITY OF ORONO * 2 0 1 5 - PJ 0 1 3 2 * 2750 KELLEY PARKWAY DATE ISSUED: OU30/2015 ORONO, MN 55356- 952 249-4600 FAX: 952) 249-4616 ADDRESS : 3926 CHERRY AVE PIN : 08-1 1'7-23-33-0019 LEGAL DESC : CRYSTAL BAY VIEW : LOT 000 BLOCK 004 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL COI�ISTRUCTION TYPE : DISCONNECTION NOTE: SEWER DISCONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 SCHERBER CO. LLC STATE SURCHARGE SEWER& WATER 5.00 11415 VALLEY DR. TOTAL 55.00 ROGERS, MN 55374 Payment(s) (763)497-1100 CHECK 16293 55.00 Minnesota State License#: mech-PB644183 OWNER WASHUTA,KENNETH 3926 CHERRY AVE MOiJND, MN 55364- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the S[ate Building Code. This permit is for only the work described and does not grant permission Yor additional or related work which requires separate permi[s. All provisions of laws and ordinances governing this type of work shall be compied with whether or not specitied herein.This permit will expire and become null and void if construction authorized is not commenced within l80 days of the date of issuance,or if construction is suspended for a period of l80 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[ime for due cause. � � �� / (/" // � pp cant Permitee Signature Date Issued Signature Date I ,�- FOR CITY USE ONLY � �-�l�I\� City of OrOno Date Received: PermiY# � �` P.O.Box 66 �� ': 2750 Kelley Parkway ❑ In-House SAC Determination Form Completed �y a ,��,� Crystal Bay,MN 55323 ��KJ S,+I F�fi (952)249-4600/Fax(952)249-4616 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 PERMITS- Mav be subiect to further review and mav not be issued when the aaalication 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 I�TOT 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) �esidential(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: �' �� %1''`' -�.. �-4�_ j Owner: � ' Mailing Address: City: ��.c Zip: Home Phone: Alternate Phone: Contractor Information: n � Contractor: ��-i��f �� Contact Person: �l� � �'�-� �� f L �l� �� State License #: Address: �� '� City: �" Zip:S�3�YExpiration Date: Phone: �D��- ��-��I 7� Alternate Phone: DETERMINING PERMIT FEES ❑ SAC Charge(2015 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) //I�-. �wer Connection/Disconnect/Repair($50.00/Per Stub) $ .� CJ-�� Pipe size inches;material Schd 40 air tested;�Ycast 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(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 Hail,these are on a senarate�ermit. ■ 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 accardance 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. � �Applicant: � �� _ �� Date: -� �� I ✓. DATE TIME CITY OF ORONO CALLED IN INSPECTION N TIC� SCHEDULED �� — � PERMIT NO. I 'L7�13 OMPLETED ADDRESS OWNER TEL H NE NO. CONTRACT�R � �� • , � DESCRIPTION ��S ll� ❑ FOOTING ❑ DEMO-FIf�AL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANIGAL RI ❑ SITE INSPECTION Q ❑ FRAMWG ❑ MECHANI�ALFINAL ❑ PROGRESS � ❑ INSULATION ❑ WOOD BU�iNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP _ ❑ AS BUILT-SURVEY ❑ SEWER H�OK-UP ❑ HARD COVER REMOVAL J ❑ DEMO-SITE ❑ SEPTIC IN TALL ❑ FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES�,NO ` // � COMMENTS: ��ZN-�!' �{i5C'� �7�9� �.'t: �,; Id � � i� !',: ' � � ,y�' :.' '-'`�7' //�• �-� � � O ^ O , 1 �. �. � � W 2 Q � 2 W � W � J ��1 WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLEfE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN INSPECTOR WIIL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REOUIRED.CALLTO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (g52) 249-46�� OwnerlContractor on site: ° �' '-� � `�� Inspector. J � � �� White Copyllnspector's File Canary CopylSfte Notice