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2015-00261 - sewer/water - repair only
� ,'� . CITY OF ORONO * z 0 1 5 - 0 0 2 6 1 * ' 2750 KELLEY PARKWAY pATE ISSUED: 03/03/2015 ORONO, MN 55356- (952 249-4600 FAX: (952) 249-4616 ADDRESS : 1971 FAGERNESS POINT RD PIIV : 18-117-23-14-0007 LEGAL DESC : FAGERNESS : LOT 000 BLOCK 000 PERMIT TYPE : SEWER& WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : REPAIR NO"CE: R}�,PAIR ONLY APPLICANT WATER CONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER&WATER 5.00 J. P. SCHMITZ CONST. CO., LLC 16450 I 17TH AVE N TOTAL 55.00 MAPLE GROVE, MN 55311- Payment(s) CHECK 2517 55.00 (763)286-1995 Minnesota State License#: SW-PB645863 OWIVER DELAY, WILLIAM & LORI 1971 FAGERNESS PT RD WAYZATA, MN 55391 AGREEMENT AIVD SWORN STATEMENT I�he work for which this permit is issued shall be perYormed according to the approvcd plans and specifications,applicable City approvals,and thc State 13uilding 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 shail be compied with whether or not specified herein.'Chis perniit will expire and become nuli and void if construction authorized is not commenced���ithin 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any time after work has commenced. The applican[is responsible for assuring all required inspections are requested in conf rnia� �ith the State E3uilding Codc.'Chis permit may be revoked a of r du cause. ��� � � �. �,� / �� � �� " � C,�`�YILe-�� i � i l� icant Permitee,ignature Date Issued By Signature Date � ,t FOR CITY tiSE ONL,Y ;-��-«�/{.� City of OrOno Date Rcceived: Pcrmit# P.O.Box bb �� 2750 Keliey Parkway ❑In-House SAC Determination Form Completed , t , Crystal Bay,MN 55323 ��.� �� s� � (952)249-4600/Fax(952)249-461G Approved By(If Required): .ifi� 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 auplication is receivedl GENERAL INFORMATION 1. You may appiy for utiliry 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 �mless tlle 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 utiliCy 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 pei-mit 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: ���� ������J� �a� ��7C� Owner: ���-�, ��,I � Mailing Address: ` G / � ���=�'�S �� c�ty: Jl�'��i , z�p: Home Phone: Alternate Phone: Contractor Information: :1 P S�`�Il�'�/7�Cb� � �j��/o���fC� 5C�/�'1�J� Contractor: � - �� Contact Person: i Address: �by5� /�7���j� State License #: ��6'���3 City: /L?V�� ���1� Zip:55�✓� Expiration Date: �-<����� Phone: ��7� �g���� Alternate Phone: ���yZ � ^�Z�� �J f � � 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 Stub) $ Pipe size inches; material__ Schd 40 air tested; cast iron .�Water Connec�ion/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 Yublic 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 I. SUBTOTAL of Pennit Requested: $ 2. STATE SURCHARGE $ 5.00 3. POSTAGE&HANDLING(Only on Mail-ln 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 work in strict accordance with tlle ordinances of the City and tl�e regulations of the State of Minnesota, and certifies that all statements made on this application are, true and correct. �l Applicant: Date: � ���— _ � � �L '/�� ��. � �� ;5 . �. � � +� .}�a S ��L �. � �" � .w,u���g�.�� �' �4� :�� '�ir, p !. µ� k k.'� � {� t r t �:.��'S �'..%i� ..`'�, t i'M`�dt� 4 � }��,.. E _� r*:$�� , ,�'r»�+ '��e . �� �' ;.s '9� } .ar�'��� `" � k �`a /� '+ m�-' s�`^ ` ;. � N b Si w . � ������,, � x_4 $i�, j J wffi'S ' �,�- � •"�` -`� �• �' � `��1: /�,�, ,,,���„� - �� a '�'�' r� i `� ti�U1�.' ��f� 'd--fYC��.' 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' �_ . �t. ._ . .„ .: ATE/ TIME � C��1(OF ORONO CALLED IN � �! � � INSPECTION NOTICE SCHEDULED 3!D -/.S /,�7 PERMIT NO. S�'�✓ OMPLETED ADDRESS l �` �WNER TELEPHO E NO� 3' 7��� CONTRACTO C� -e� � DESCRIPTION Gy�2�C� � . ly ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING O ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ PROGRESS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP _ ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ HARD COVER REMOVAL v ❑ DEMO-SITE ❑ SEPTIC INSTALL ❑ FOUNDATION/REMOVAL 2 OWNERICONTRACTOR TO MEET YOU:_YES_NO � � COMMENTS: ��� � �� �f�� � �J�PU��C� - a G'�'��'��/Y� �i�E',3'}� �i!�!�S�� �L' 112 l��' � � o � n /�-t,3-� . �0'irC,�v' l�t.���"� �!��� �" ,t�l Cf-cGh.ed �f'�tl� ° � .ri -dv� ,� C r�,6 W � �� r �f� Q � 2 W � W � j W �ORKSATISFACTORY:PROCEED �PROJECT COMPLEfE � RRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W � ❑CORRECT WORK,CAIL FOR REINSPECTION TEMPORARY � BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN INSPECTOR WIIL REfURN �STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑iNSPECTION REQUIRED.CAIL TO ARRANGE ACCESS. Cail for the next inspection 24 hours in advance. (952� 249-460� OwnerlContractor on site:��D SG .� �'� Inspector_ ��f��� White Copyllnspector's File Canary CopyfSfte Notice