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Home My WebLink About2015-00125 - sewer disconnect CITY OF ORONO * z 0 1 5 - m 0 1 2 5 * � 2750 KELLEY PARKWAY DATE ISSUED: 02/02/2015 ORONO, MN 55356- � 952 249-4600 FAX: 952 249-4616 ADDRESS : 960 FERNDALE RD W PIN : 02-117-23-44-0017 LEGAL DESC : COUNTRY CLUB ESTATES : LOT 000 BLOCK 000 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTTON TYPE : DISCONNECTION NOTE: SEWER DISCONNGCT APPLiCAI�IT SEWER CONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER&WATER 5.00 J S STEWART COMPANIES, INC. MAIL-IN FEE 2.00 11099 LAMONT AVE NE TOTAL 57.00 HANOVER, MN 55341 �� Payment(s) CHECK 6087 57.00 OWNER BROOKS,JOHN&JOAN 960 FERNDALE RD W WAYZATA,MN 55391- AGREEMENT AIYD 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 addi[ional 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 afrer 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 revoked at any time Yor due cause. � L�/� J �l � �1,�,� _. � � ( �yn c� �� 2-- � �Z � r��. Applicant Permitee Signature Date Issued By Signature Date ----- . FOR CiTY USE ONLY �f�� r��•` City Of�OrUnO DateReceived: ____ Pc;rmit# ,� P.O.Box 6b I �� 2750 Kelley Parkway ❑In-Flouse SAC Determination Form Completed a , .�,�� Crystal Bay,MN 55323 `��-�*'� (952)249-4600/Fax(�JS?)249-4616 Approved By tif Required): _ a, ,�f:'/ CITY (JF ORONO—SEWEIZ& WATER/GENERAL PERMiT (*Note:Some perniits m�y require approvai by the Buiiding OfticiaE andior Pubiic Works Department�'1 (ALL PERMITS- Mav be subicct to further review and mav not be issued Nhen the aoalication is received) GENERAL INFORMATIUN 1. You may apply for utility permits by mail or in person at the City ofTices. 2. Mailed in applications are subject to the postage and handling fee shown below. Permit cards will be sent by return mail within 2 busine�s days. 3. Yermits are not valid untit you receive a permit card. 4. W�rk must not begin u��les�the pera��it card is a��zilabte en thP jo�si?e. 5. Utility connection pennits may be issued to licerised contractors only. 6. Contact the Public Works Department(952-249-4600}for urility stub as-built locations. DO NOT EXCAVATE iN ANY STREET AND DC)NOT TAP ANY MAIN without express approval of the Public Works Department. Issuance of a permit does not grant this approval. 7. Ail work must be done in accordance with State Code requirements. 8. All work must be inspected before it i;covered. Ca1[(952)249-4600,24+hour notice required. TYPE OF PERMIT � (Check All That Apply) [�Residential(May Require Approval) [_]Commercial(Approval Required) S�.��v �� New Connection (,�]Additional Connection (� Re-Connection [-]Repairs [�Disconnect Q Water Availability Connection F'or Future Hook-Up to Water � Jab Site/Owner Tnformation: Site Address: �� '�'�C�C�-�'� �(� � Owner: �(��t1V '�JY�'-D�.� Nfai ling Address: �� ,(/{��Q_�"� City: �� .�; L� Lip: ��-�'� � Home Phone: Alternate Phone: Contractor Inforrnation: 1 __� Contractor: ��,�,� .�,1/�l� �� t� Contact Person: �' l✓i�-l:� Address: �( O�C L��Cl.l1Y�,�'��Q.I�State License#: City: �� iT Lip�J�f Expiration.Date: Phone: 7�"�-y-Z�—�L��L� Alternate Phone: �� ' ��r� � . DE"I'�RMINING PERMIT rEES ❑ SAC Charge(201.5 Rate=$2,485AOj S (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) :-v �-` ��.� . �Sewer Connection�sconnech/Repair($50.00/Per Stub) � Pipe size inches;matenal 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 F'uture Hook-Up to Water($50.00) $ Water Avaitabilitv Explanatinn: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Pubiic Wocks 17eparement. Rec{uired Before Water Connection Permit is Issued: I. Issue Water Meter&Narn Permit 2. Any Additional Connection Fees Paid(1f Applicable) Issue Water Connection Permit: l. Collect Permit F�ee&lssue Water Connection Pennit 1. SUBTOTAL of Permit Kequested: $ 2. STATF SURC�iARGE $ 5.00 3. PO5TAGE& HANDLING(Oniy on Mai{-In Applications) $ 2.U0 Ou 4. TOTAL PERMIT FEE(Add Lines 1-:i Above) $ � 7 — � �� ADDITIONAL INFURMATION--WATER JVIETERS � � ■ WA"TER METERS must be picked up and paid for at Orono City Hall,these are on a senarate permit. • WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon completion of ineter instailation. The une�ersigned l�ereby applies to the City of Orono for issuance of a Utility Perrnit, agrees to do all work in strict accordance with the ordinances of the City and the regulations of the Sta#e of MinnesoCa,and c rtifies th 1 statements made on this application are,true and correct. i Applicant: '�� Date: � "� '"IS V . DATE TI�j i�/ CITY OF ORONO CALLED IN �-�3 � J� IN SP E CTION N T�,� ,�f jSCHEDULED � -5 —/.S � PERMIT NO. ��COMPLETED ADDRESS D � OWNER TEL H E NO � �� CONTRACTOR L � DESCRIPTION ��/ �0�� -�� tL ❑ 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 ❑ PROGRESS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP i ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ HARD COVER REMOVAL J ❑ DEMO-SITE ❑ SEPTIC INSTALL ❑ FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEEf YOU:_YES_NO y COMMENTS: a /�// � � � 0 � � 0 � W � Q � 2 W � W � J W �WORKSATISFACTORY:PROCEED C�PROJECTCOMPLEfE � ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALI FOR REtNSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ PHOTOTAKEN INSPECTOR WILL RETURN �STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call forthe next inspection 24 hours in advance. (952) 249-4600 OwnerlContractor on site: --� S 5��/g-'� Inspector. �'�/�',� White Copyllnspector's Ffle Canary CopylSite Notiee