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Home My WebLink About2015-00913 - s/w disconnection CITY OF ORONO * Z 0 1 5 — 0 0 9 1 3 * �,, 2750 KELLEY PARKWAY DATE ISSUED: 07/2U2015 � ORONO, MN 55356— 952 249-4600 FAX: (952) 249-4616 ADDRESS : 2755 ETHEL AVE PIN : 20-117-23-24-0017 LECAL DESC : CASCO HEIGHTS : LOT 006 BLOCK 003 PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION APPLICAIYT SEWER CONNECT/DISCONNECT/REPAIR 50.00 WATER CONNECT/DISCONNECT/REPAIR 50.00 TUMA CONSTRUCTION STATE SURCHARGE SEWER&WATER 1.00 5045 COUNTY ROAD 19 M[NNETR[STA, MN 55359- TOTAL 101.00 (763)479-2982 Payment(s) Minnesota State License#: BUIL-PB695614 CHECK 4664 ]01.00 OWNER Everlast Enterprises, Inc. CLEARY,JAMES 4109 NORTH SHORE DR 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 not grant permission for additional or related work which requires separate permits. AII provisions of laws and ordinances goveming this type of work shall be compied with whether or not specified herein.This permit will expire and become null and void if construction au[horized is not commenced within 180 days of the date of issuance,or if construction is suspended for a period of 180 day at any tim e has commenced. The applican s espons e r assuring a equired inspections are requested i c form e w� the Stat uy}ding Code.This permit may be revoked a time r du cause. � t, /� � sL-t-S� �7 i�t i ( 5 Ap 'cant Permitee Signature Date [ssued By Signature Date ! `r - FOR ITY.U5 ONLY i g-O/�I City of Orono Date Received: Z( _ Permit# �-0�{�(`, �3 � �\` P.o.aoX 66 � 1y j � ! 2750 Kelley Parkway ❑ImHouse SAC Determination Form Completed � `, � � t,,- Crystal Bay,MN 55323 �. .�:� (952)249-4600/Fax(952)249-4616 Approved By(If Required): ��ECHOSiF � 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 receivedl 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 handiing 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 A1�IY 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 � C�'�U- � — t� `�'�Q/y�J� Czh�c. Owner: � v -�1�� c�S � Mailing Address: City: Zip: Home Phone: Alternate Phone: Contractor Information: , �-� ,� � �' � _--- . Contractor: � �-�'� � C��L��ontact Person: � ��--�� -w'�-�? ��1, � � � S Address: S ��J ��w"'�7` �""'"�tate License #: � � � � � � � ,-�.s-�"1 City: ��` ��'��''-�� Zip:S `5 Expiration Date: Phone: �� Z` �� s�3 5 S 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) --� ,' '� � Sewer Connection/Disconnect/Repair($50.00/Per Stab) $ Pipe size inc mat@ri�(� Schd 40 air tested; cast iron � �Water Connection isconne�f/Repair($50.00/Per Stub) $ Pipe size inches; mater�al 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 $ 1.00 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 separate permit. ■ WATER METERS mast be set and sealed by Orono Water Department (952) 249-4600, upon completion of ineter installation. The undersigned hereby appli to the City of Orono for issuance of a Utility Permit, agrees to do all work in strict accorda e ith th es of the City and the regulations of the State of Minnesota, and c�ert�es at ll s ateme made on this application are,true and correct. r` �� -7 - Z ( - ( 5 Applicant: :� Date: U 5�� ,� ►- DATE TIME CITY OF ORONO CALLED IN INSPECTION NOTICE SCHEDULED �� PERMIT NO. Z�C'15-c�9f3 COMPLEfED ADDRESS �� ,�'�L' f 17�LG� OWNER TELEPHONE NO. CONTRACTOR ��-- � DESCRIPTION ��-`"�� tSC�G�h�� ll� ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP _ ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL J ❑ DEMO-SITE ❑ SEPTIC INSTALL Q OWNERICONTRACTOR TO MEET YOU:_YES_NO 2 J �- � COMMENTS: w/��2�- Sr�r�/ S��if��'.�c%c�S''�v� a � �" i. �dl1 S� .s��C�/n� �� C'�-'/'� S7`� � b J O ). o �/ /I s��w��- St�/'vrc�' C��.�,�� %-�-�,�e� ,�. � z W � W � j d 4�WORKSATISFACTORY:PROCEED �OJECT COMPLETE ��O CORRECT WORK&PROCEED ❑ ISSUE CERT�FICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORECWERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL REfURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (g52) 249-4600 OwnerlContractor on site: �L�''�/"i` �X C' Inspector. �C C�^��— White Copyllnspector's File Canary CopylSite Notice