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HomeMy WebLinkAbout2015-00070 - sewer connect � ' CITY OF ORONO * Z 0 1 5 - 0 0 0 7 0 * 2750 KELLEY PARKWAY DATE [SSUED: OU22/2015 ORONO, MN 55356- (952 249-4600 FAX: 952 249-4616 ADDRESS : 1141 ELMWOOD AVE PIN : 07-117-23-14-0027 LEGAL DESC : SKARP& LINDQUISTS FERNHILL LA : LOT 007 BLOCK 000 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTIOI'�1 NOTE: NEW SEWER CONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER&WATER 5.00 DERUDDER EXCAVATING TOTAL 55.00 4910 HICKORY HILLS TRAIL PRIOR LAKE,MN 55372- Payment(s) CREDIT CARD 1206 55.00 (952)447-8921 Minnesota State License#: plbg-073940 OWNER ALNESS, RYAN& STACY 1141 ELMWOOD AVE MOUND, 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 State Building Code. This permit is for only the work described and does no[grant permission for additional or related work which requires separa[e permits. All provisions of laws and ordinances goveming this type of work shall be compied with whether or no[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 l80 days at any time after work has commenced. The applicant is responsible for assuring alI required inspections are requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. � � � ��/S Applicant Permitee Signature Date Issued y Signature Date I I � -��`0�� City of Orano rak "►T ' �i� Se o�I.t' P.O.I3ox b6 Date Received:�- /- crmit# /5- 7� � � � 27�0 Kellcy P�rkway � � C'rvstal�ay,�QN i5323 ❑1n-House SAC Determmation Form Compieted ';��,ti`��� (9S2)249-4b00/Fax(952)249-4G 16 A �'"f`'- � pproved BY(Ii°Itequired): C1TY pF ORONO—SEWER& WAT�R t GENERAL PERMIT (*'�ote Some permits may reyu�re approvai by the Building C)tficiat and/or Public Works Department*) (A1.L PF.R'4iITS- ��ta be suhiect to further rer•iew and mav not be issued when the au t�rat�nn�s______recri,ived) GENER�L INFOEZM�TION I• You may app(y for utility pennits by ma�l or in persoo at the City offic�s. 2. Mailed in applications are subject to the postage and handling fee show�n below. Pennit cards wil! be sent by return mail within?bttsiness days. 3. Permits are not vaiid untii you receive a pern�it card. 4• �i�'ork must not begin unless the permit card is avai(ahle on the job site. 5. Utility connection permits may be issued ta Iicensed contractors onlv. 6. Contact the Public Works Depaitment{952-249-4600)for utility stub as-bt�ilt locations. DO NOT EXCAVA'TE IN AiV'y STREET A,'�f)DO NOT TAF ANY MA�IIv without express approvai af the Public Works Depart►z�ent. (ssuance c�f a pern�it does not grant this approval. 7. Atl work inust be done in accordance with State Code requirements. 8. A11 work must be inspected before it is covered. Cail (952}249-4600,24+hour notice reyuired. TYPE OF PERMIT Check All That A I �esidentia((May Require Appraval) ❑�'on�mercial(Approval Required} .,. �'�tew Connection ❑Additiv��al Connecti�n ❑Ke-Connection ❑Repairs ❑Disconnect ❑ Water Availability Coimection For Puture Hook-Up to Water Job Site I Owner Information: Site Address: � � �' � �-� r-� ���������;��, Owner: t-�'Ct,�1:..,.�r�,'�'1fl`����"� -��l 3���� Mailing . Address: �� ���%�;��t.�i��7�r,� �l�=�� , City: r"�'�'��'`��S ( �'`�✓�. Zip: �`.� �� _-�' , --,�, ; Hame Phone: �� '`�t. �—� � t "� I A lternate Yhone: Contractar lnformation: -�., .� . ... Contractor: �..=�(�-�.L�.���;��' �;-�(��t�rf�17'� Contact Person: c..,�� �S{'.tC.-��,("�C'�.�.d'"� Address: �{ r~')(�;-�--�":7C,��:;iG�t:{ �-�x i�5`��G''� State License #: City; fi�Vl `;�' ! ,� % Z.i� ���j.�`�;�E�piration Date: Phonc: ��)�� ��--�� �t'���� t Alternate Phone: �`( �,,. C��t� �---{� ��-� w � �------`—. DE'T'ERMINIT�IG I'�RMIT FEES ❑SAC Charge(2015 Rate=52,485.00) � (SAC Char�e must accompany all sewer permit applications unless prepaid} (Orono City Staff can detennine if applicable) (tf nut prepaid,a sewer connection permit wilt naf be issued) �Server Connection/Disconnect/Repair(�SQ.00/Fer Stub) � � �` � �-�'' Pipe si•r.e_^ inches;material��-'�' Schd 40 air•tested;�_casi iron �,� 1Vater Connection l Disconnect/Repair($50.00/Per Stub) � Pipe size inches;material��Schd 40 air tested;_____�oPper � � ❑Water Availabiiity For Futnre Hooic-Up to Water('$50.00) $ `�'ater Availabilitv Exnlanation• Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Departmeot. Rec�uired Before Water('onnection Permit is Issued: ` 1. Issue Water Meter& Horn Permit 2. Any Additional Connection Fees Paid(IfApplicable) lssue Water Con��ection Permit: �. Colleet Rermit Fee&Tssue Water Gonnection Permit l. SUBTOTAL of Permir Requested: � ���`j �`;� 2. STATL SURCHARGE �_ 5 Q� � 3. POST.qGE&F�tAI�rDL.1RG(On1y�n Vlaii-In Applications) $_ -2,04- 4. TOTAL PEF211[T FEE(�dd Lines 1-3 �bove) � �j� `';�� , ADDITIONAL INFORMATION— WATER METERS ` W.ATER 1�IETERS must be picked up and paid for at Orotao City r1a11,these are on a separatepermit. � WATER �IETERS must be set and seated by Orano Water Department {9�2) 249-4600, upon com��letian of ineter installation. The undersigned hereby applies to the City oi'Orono for issuance ofa Lltility Yermit, agre�s to do ail work in strict accordance with the ordinances of the City and the regulations of the State of Minnesota,and certit7es that all statements made on this application are,true and correct. /' j� ' �- Applicant: U `� ��, Date: � ��1 {�� , E `�. siaT� oF nni�rvEs��r,� � 'CHF�S 3 FEf#T�FgEIt A�PELAYER r�� r�c, . ,�� ; n�� L!U i�.:SP,# Q 7 Jr'��s�—�i':' "'`it-�,�-�-�a>i: 1 w s � F Ext� <:�tian Cate �,'����;.�t Or.,it��a� C��ie lssusd `�'f.c�,�q�;1�" JEFFt2�Y C �.�!_Rt3Z%�'�F� 49�t� F�I�KG�;: � B�I�.�_S �e�� PRIOR L,Ad{� , MiV �5372 'd�'�' a' -. {�+� .� ��" *�''��; �=� �• ,a� � ,.� . .•< � � �. �,.� a ,, '.��,� , • ,.: ,_ , ;.� .� .. � . � � , � . . , � "� � � _ , $ �. , � � � `.' �4°... •� � !� ¢_ ,_ ��, ,�. - + " � ' -�t �> { �I dl I ��, "', s"�..��e� . ' �`� .z�. � � _a: d�II� �� • � . _� .r� .& > - . 'y.. W���` .a d! ... _. .,...� � ' ! ;� ,. 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S� DATE TIME y CITY C�ORONO CALLED IN J-/�-/S `INSPECTION N ICE SCHEDULED /�'-/S PERMIT NO. �� �� D PLETED ADDRESS � �� OWNER TE HONE NO. `� CONTRACTOR � ��' >: DESCRIPTION G� � � ❑ FOOTING ❑ PLUMBING FINAL �"�/� � ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL � MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL �SEWER HOOK-UP ❑ COMPLAINT v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP � ❑ DEMO-FINAL ❑ SEPTIC INSTALL � HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNERICONTRACTOR TO M F�T YOU:_YES_NO , 1 � COMMENTS: T7 r'�f � �j" /I� �w � �t-� /��J L;� � � ,:s :..� '� Sl� �i� �,1� �� �� � _ O ;! � � ! `) 5 ,' vE.- , � �;{'�-.�' ; f� .j� �� � '�F��7' /V�� ��C%�?�'7 � �-� � J�� ��, �,�y,.. . . P O "L..� �..`.: --_ � W � Q � Z W � W � j d'� % W ISWORKSATISFACTORY:PRdZ�EE� ❑ PROJECTCOMPLEfE � ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERT�FICATE OF OCCUPANCY W O ❑CORRECT WORK,CALI FOR REINSPECTION TEMPORARY V BEFORE CWERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN INSPECTOR WILL REfURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 urs in advance. �J52� 249-4600 OwnerlContractor on site: t�, �V�j� [`r ��'�`<� Inspector. ��� �� White Copyllnspector's File Canary CopylSite Notice