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Home My WebLink About2016-00933 - disconnection CITY OF ORONO * Z 0 1 6 - 0 0 9 3 3 * - 2750 KELLEY PARKWAY DATE ISSUED: 08/08/2016 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 1700 BOHNS POINT RD PIN : 16-117-23-22-0003 LEGAL DESC : AUDITOR'S SUBD.NO.349 : LOT 003 BLOCK 000 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION NOTE: DISCONNECT ONLY APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER&WATER 1.00 GROTH SEWER& WATER TOTAL 51.00 775 TOWER DRIVE HAMEL, MN 55340- Payment(s) (612)919-0247 CHECK 8941 51.00 O W 1vER SANTRACH&MELISSA KREIMER-SANTRACH, PETER 1700 BOHNS PT RD WAYZATA, MN 55391- AGREEMENT AND SWORN STATEME1vT The��ork for which this permit is issued shall be performed according to the approved plans and specitications,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. 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 da[e of issuance,or if construction is suspended for a period of I 80 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 revo�e�. t any time for due cause. � C � ,� � _ - �'' � � � ��-t6 ��, �, � � f'�� : - � � -�' � 1 �� Appl t ermitee Signature Date Issued By Si ture Date Y �=�--., Fo�� us�o�vi.v � ,�/� 3� ��- �1O�, City of Ol'oao Date Received: _�� Permit# � �) �� l"'� �' �, P.O.Box 66 � ' � ` 2750 Kelley Pazkway ❑In-House SAC Determination Form Completed �-�' Crystal Bay,MN 55323 �\\��.i',�'�¢j j (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 Departrnent') (ALL PERMI7'S- Mav be subiect to lurt6er review and mav not be issued when t6e aoulication 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 retum 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 ANY MAIN without express approval of the Pubtic 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 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 Wate� Job Site/Owner Information: Site Address: _� � UU �v�� U�n-+ �� Owner: ��"� �u�,��r�� Mailing Address: �. (-le�h;��a� q�� S ��(v-7 City: 1�;,.��ua�> > ;� Zip: S SK U� L c i l � }'��G� Home Phone: -�1te�ate�Phone: �S l -3U� - Contraczor Information: Contractor: (,��I-1, S r w?� 4�L�l�,.�-��r L L(�ontact Person: L3;�1 11��I`CJ Address: �Z�S TQw.'� �r��✓� State License#: PL6Y��' City: �u^�c'� Zip:SS 3 YGExpiration Date: l�.' �l " t 6 Phone: ��-`�l y ��a'y� Alternate Phone: 4 D�TER:MINTN�i 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 isconnec /Repair($50.00/Per Stub) , $ Pipe size�inches;material 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 Exnlanation: Contractor installed line to inside of house for future hook-up. T'his line will be inspected by the Public Works Deparhnent. Required Before Water Connection Permit is Issued: 1. Issue Water Meter&Hom 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) S ADDITIONAL INFORMATION—WATER METERS ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separat�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 accordance with the ordinances of the City and the regulations of the State of Minnesota, a ertifiesxhat all statements made on this application are,true and correct. .--'" Applicant: Date: �� ; .s Q' �lTEJ TIME �v� CITY OF ORONO CALLED IN �� l �s�— INSPECTION 110TICE SCHEDULED � PERMITNO. ��—�� MPLEfED ADDRESS �7� F OWNER TELEPHONE NO.� " � �� CONTRACTO �� v �� DESCRIPTION ^"�`5 �� 4~j ❑ 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 � W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL Z � ❑ DEMO-SITE ❑ SEPTIC INSTALL 2 OWNERICONTRACTOR TO'EET YOU:_YES_NO v�, COMMENTS: / 'S C/ � � �� S� a ° � J O ). � ^/� / � o �r/ W � Q � 2 � + W � j a � WORKSATISFACTORY:PROCEED ROJECT COMPLEfE ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTAKEr; INSPECTOR WILL REfURN ❑CITATION 19SUED ❑STOP OROER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 2a hours in advance. (952) 249-46�0 OwnedContractor on site: ' � Inspector. � - White Copyllnspector's File Canary CopylSite Notice