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2012-01036 - sewer disconnect
CITY OF ORONO * 2 PJ 1 2 - P1 1 P1 3 6 * � 2750 KELLEY PARKWAY DATE ISSUED: 10/16/2012 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 1105 FERNDALE RD W PIN : 02-117-23-43-0033 LEGAL DESC : REG. LAND SURVEY NO. 0441 : LOT MB BLOCK MB PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENT[AL CONSTRUCTION TYPE : D[SCONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 OUVERSON SEWER& WATER P O BOX 247 STATE SURCHARGE SEWER& WATER 5.00 LORETTO, MN 55357- TOTAL 55.00 Minnesota State License#t: MR86668 OWNER TRUWIT, CHIP 1105 FERNDALE RD W WAYZATA, MN 55391- AGREEMENT AND SWORN STATEMENT The work for which this pern�it is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the Sta[e Building Code. This permit is for only the work described and does not grant permission for additional or rela[ed work which requires separate permits. All provisions of laws and ordinances governing this type of work shall be compied with whether or not specitied herein.This permi[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 Cor a period of 180 days at any time after work has commenced. The applicant is responsible for assuring ali required inspections are reques[ed in co rmance with the State Building Code.This permit may be revok y time for due cause. / / / / r plica rmitee Signature Date Issucd By ' nature Date SEPARATE PERMITS REQU[RED FOR WORK OTHER THAN DESCRIBED AB , �._ � FOR CITY USE ONLY 4 0,�` Clty of Orono Date Received: Permit# "r P.O.Box 66 �' � 2750 Kelley Parkway �' �wa ❑ In-House 5AC Determination Form Completed a ����A;�_ Crysta]Bay,MN 55323 �d����u�f;��-�.�o� (952)249-4600 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 Department*) (ALL PERMITS- Mav be subiect to further review and mav not be issued when the application is received) GENERAL INFORMATION L You may apply for utility pemuts 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 unless the pernvt card is available on the job site. 5. Utility connecrion permits may be issued to licensed contractors only. 6. Contact the Public Works Deparrinent(952-249-4600)for urility 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 pernut 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: I �� s (' �� ��.� '�� �.1 Owner:�fCJ Tr��^' ' �' Mailing Address: City: Zip: Home Phone: Alternate Phone: �p � � �Z S S�IS C Contractor Information: Contractor: �%��"��r��'1 �"�"'"�� Contact Person: � Address: /' � �"x Z`17 State License #: /`7� �� �� � City: �°'�� Zip:SS 3S� Expiration Date: � � � Phone: ��Z �S�� � ��� Alternate Phone: ��L �s / - ��'t�`� DETERMINING PERMIT FEES � ❑ SAC Charge(2012 Rate=$2,365.00) $ (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/Disco►Yr►ect/Repair($50.00/Per Stub) $ Pipe size `1" 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 Availabilit��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 Pernut is Issued: L 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 Pernut Requested: $ 2. STATE SURCHARGE $ 5.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMTT FEE (Add Lines 1-3 Above) $ ADDITIONAL 1NFORMATIOI�T—WATER METERS ' ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate pernut. ■ 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, a�rees to do all work in strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that a atements made ri5 application are, true and correct. 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' { ... �o�� 'l",�� � .'�a. � : ♦� � .. �A 1 . - .. - , + • • " s - �+ur�� ��� A�ti.��- � •^ �. '\} " . *.� . , ..e.�� .e+ � � ,. � + � ' .w r , r e . . ,. �'1' s�"it . � � . '�' . .,.t \ i..�� '.. '� } »."I t, - . � .. .1�'� , . �..+ s - .. _ ;.... _ ...., .. . �. r -a w ��" ` � , .;" x„"'�' 9 „ ' � ,� •'� _ "'�4 .. ` O+s. �# � . �y'.�:� .. ,. * � a - . .. '� � I'... ��. � ` . � +1�� *�. �: ! �h� �. '�'�� ���� i ' � �� � - �� � � � � �" ��� . �� �� �J �+_:��p�.� .� '�" 1.. : ,� `�► � �� �' ' � �� � . � � �, "� ," �� ,��,,,,, `p�'. x �„ �`- ,� i . • � '�` + 1 ��� � ��'lK' � � r � , .� .. �4 . e � y♦ . q ` � � DATE TIME CITY 6F ORONO CALLED IN INSPECTION I���IaCE�,D 3 � SCHEDULED lD-� -1 Z PERMIT NO. °C COMPLETED ADDRESS ��05 �erho(�� /�2.� (� OWNER TELEPHONE O. CONTRACTOR DU V P�{^�pYl 5� �: DESCRIPTION ��� ��S�'�'�`�� � � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS � ❑ FRAMING ❑ MECHANICAL FINAL Q ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q � RADON SlA6 ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS:�y��l'-`95� Z��� ���� wi fl'l � S�-�� � �s f �- C.�t`i � �-�9. � O >. � O � W � Q � Z W � w � � a W ❑WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE � ❑CORRECT WORK&PROCEED rl ISSUE CERTIFICATE OF OCCUPANCY W Q ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORE COVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pHOTOTAKEN INSPECTOR WILL RETURN u CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS. Call for the next inspection 24 hours in advance. �952� 249-46QQ OwnerlContractor on site: �U Ue/'S m r✓ � ����, Inspector. ��� White Copylinspector's File Canary CopylSite Notice