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Home My WebLink About2015-01067 - sewer disconnect CITY OF ORONO * z 0 1 5 - 0 1 0 6 7 * 2750 KELLEY PARKWAY DATE ISSUED: 08/20/2015 ` ORONO, MN 55356- (952) 249-4600 FAX: 952 249-4616 ADDRESS : 1050 EDGEWOOD HILLS RD PIN : 02-117-23-13-0003 LEGAL DESC : REG. LAND SURVEY NO. 1098 : LOT 000 BLOCK 000 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE��5-CONNECT[ON NOTE: SAC PAID#11815 09/02/1999 APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER& WATER 1.00 OLSONS SEWER SERVICE TOTAL 51.00 17638 LYONS ST NE Payment(s) FOREST LAKE,MN 55025- CREDIT CARD 8126 51.00 (651)464-2082 Minnesota State License#: SW-1R654644 OWNER EHRAMJIAN, VARKES 1050 EDGEWOOD HILLS RD WAYZATA, MN 55391- 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. 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 date of issuance,or if construction is suspended for a period of 180 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 l revoked at any time for due cause. �C�� / �-'�L� � � �� _ �ZQ� -�� _ A icant Permitee Signature Date [ssued By Signature Date From: OS/20/2015 10:�8 #797 P.002/003 1 ' FO C1TY tiSE ONLY ��}�`��`--.. CII�'O��COtlO DateReceived �; (C�'ermit# �-�._ '��>'�t�� i� P.O.Box 66 � I �4` 2750 Kelley Parkway ❑in-Iiouse SAC lletennination Fonn Completed „\, � �:; Crystal I3ay,MN 55323 �/� � . <�.. ��.' (95?)249-4600/Fax(952?249-4616 Approved B (If Re uired): L/ �� . �ri�{�,o-� �� '`�� (v e. � � 3� �---�— CITY �F ORONO— SEWER & WATER/GENERAL PERMIT (*Note Some permits may require appro�al by the Building Official and/or Yublic Works Department•) (,1LL PERMITS• Mav be subiect tu furf6er review and mav not be issued w6en the upplication is recei�ed) GENERAL II�IFORMATION 1. You may apply for utiliry permits by mail or in person at the City offices. 2. Mailed in applications are subject to the postage and handling fee show�n below. Permit cards will be sent by return mail within 2 business days. 3. Permits are uot valid until you receive a permit ca►•d. 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. b. Contact the Public Works Department(952-249-4600)for utility stub as-buitt locations. DO NOT EXCAVATE I!�'ANl'STREET A',��DO NOT TAP A�TY 11�[AIN without express approval of the Public Works Departmenk Issuance of a permit does not grant this approval. 7. All�vork must be done in accordance with State Code requirements. 8. All work must be inspected before it is covered. Call(9�2)249-4600,24+hour ootice 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-L1p to Wat� Job Site/Owner Information__ —� Site Address: � � 5 � �� C �[`�' I � �C�_�„r 5fire-e-�tY �s n G c�.�c. . � Owner� S Mailing Address: ' �3 I�.... Y��n� c�� o��r �,c��-- z�p: 5539 � �31Yd- Home Phone: Alternate Phone: Contractor lnformation: – �rVl�� ( Contractor� ��SpV�is L��l!� Contact Person: �l 01(1 Aaa�s�°3$ �m�s S� �C state �,��°'�' len� _ f yL i�5� (��{-� �Y�st- t.�-�c¢.� �55u?� .� City: �p: Expiration Date: � �J ( �S Phon��IJ ��y 2'a�� Alternate Phone� ��1 Z� g '"� U�J � From: OB/20/2015 10:49 #797 P.003/003 ;_._DETERMINiNG PERMIT�E�S -- ___� ❑SAC Charge(2015 Rate=�2,485.00) $ (SAC Charge must accompany all sewer permit apnEications unless prepaid) (Orono City Staff can determine if app]icable) (If not prepaid,a sewer connection permit w�ill not be issued) �Sewer Connection/Disconnect/Repair($50.00/Per Stub) $ S� �0 Pipe size inches;material Schd 40 air tested; cast�ron ❑Water Connection/Disconnect/Repair(�50.00/I'ei•Stub) $ Pipe size inches;material Schd 40 air tested;____ copper ❑Water Avaiiability For Future Hook-Up to�'ater($50.00) $ V1'ater Availabiiiri Exptanation: Contractor instalfed tine to inside ofhouse for future hook-up. This line will be inspected by the Public�'orks Department. Required Before Water Connection Permit is tssued: 1. lssue Water Meter& Hom Permit ^ 2. Any Additional Connection Fees Paid(If App(icable) Issue Water Connection Permit L Collect Permit Fee&Issue Water Connection Permit I. SUBTOTAL of Permit Requested: $ 50. �v 2. STATE SURCHARGE $ 1 00 �.c' �11.1+� 3. POS"1'AUE&HANDLIN('�{Only on Mail-In Applications) $_ �_._�.�ti�� 4. TOTAL PERl�11T 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. ■ WATFR METEI7S must be set and sealed by Orono Water Departme��t (9S2) 249-4600, upon comp{etion of ineter installation. The undersigned hereby applies to the City of nrono for issuance of a Utility Permit, agrees to do all ��ork in strict accordance with the ordinances of the City and the regulations of the State of Minnesota,and certifies that all statements made on tlais applicatian are, true and correct. Appl�cant: Date: (�1� �Z� !Z-�f.� J-5 . `� `� T TIME `� G DA E CITY OF ORONO CALLED IN 7 "� INSPECTION O I�j�i' �CHEDULED 9� l�� PERMIT NO. , 7 � /connP ADDRESS � �d D � I OWNER T HONE NO — ��S CONTRACTOR � ' �� DESCRIPTION — lN ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING y ❑ 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 4J ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL 2 J ❑ DEMO-SITE ❑ SEPTIC INSTALL 2 OWNERICONTRACTOR TO MEET YOU:_YES_NO y COMMENTS: b4 5� �/'e �'l �I �� \Q C a ee_d. �-o o .� �o c� � � J 2/l/�' 0 � 0 � W � Q � 2 W � W � � J W�RKSATISFACTORY:PROCEED �, PROJECT COMPLEfE � ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY w � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN INSPECTOR WFLL REfURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call forthe next inspection 24 hours in advance. (g52) 249-46�� OwnerlContractor on site: (� �S�n S Inspector. �C.Q� White Copyllnspector's File Canary CopylSite Notice