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Home My WebLink About2013-01197-voided CITY OF ORONO * Z 0 1 3 - 0 1 1 9 7 * ' 2750 KELLEY PARKWAY DATE ISSUED: 1U12/2013 ` 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 : RESIDENTIAL CONSTRUCTION TYPE : RE-CONNECT • / ` � ` � � ` ` APPWCANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 DELSON PLUMBING, INC. STA SURCHARGE SEWER& WATER 5.00 1308 42 1/2 AVE.NE MINNEAPOLIS, MN 55421- TOTAL 55.00 �� PAID WITH CC# 0876 Minnesota State License#: PC000954 OWNER TRUWIT, CHIP 1105 FERNDALE RD W WAYZATA,MN 55391- AGREEMENT AND SWORN S TEMENT The work for which this permit is issued shall be erformed according to the approved plans and specifications,applica City approvals,and the State Building Code. This permit is for only e work described and does not gran[permission for additional or rela work which requires separate permits. All provisions of laws and ordi nces goveming this type of work shall be compied with whether or not � ecified herein.This permit will expire and become null�nd void if nstruction authorized is not commenced withiry 180 days of t date of issuance,or if construction is suspended for a period of,k8a day;�Q any time after work has commenced. The applicant is responstble fqr'a�su 1�all required inspections are requested in ebnformance�y,ithQhe�tate Building Code.This permit may be revo ed at any time t d�craus�C. , ' �r i /,1 i %� i i Applicant Permitee Sig ture � Date Issued Bv Si ature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER AN DESCRIBED ABOVE. FOR CITY USE ONLY -��Z��%�%�'\ City of Orono Date Rcceived: _ Pennit# �J '� P.O.Qox 66 �� 2750 Kcllcy Parkway ❑In-1{ouse SAC Determination Form Completed i , � Crystal Bay,MN 5i323 � ��, (9�2)249-4600/F�ax(952)249-4616 Approved 13y Qf Required): CITY OF ORONO— SEWER & WATER/GENERAL PERMIT (�Nute:Some permits may requirc approval by the Building Of7icial and/or Public Works Dcpartmcnt*) (ALL NEKMI'I�S- llav be subiect to further review and mav nut bc issued when the application is received) GENERAL INFORMATION I. 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 return 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)far utility stub as-built locations. DO NOT EXCAVATE IIY ANY STREET AND DO NOT TAP ANY MAIN without express approval of the Public 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 Water Job Site/Owner Information: Site Address: � � 0 5 ��e,� n d a L� �� Owner:l�h 1� �I" l.l W � � Mailing Address: � 1 �5 �/X�0.CC� /�d VV c�ty: Lt�a�l z�.�cL z�p: �� 3 4 � Home Phone: Alternate Phone: Contractor Information: Contractor: ��vo,7 �Lumbi/�q ContactPerson: UGVP. O150� �J Address: I �v 0� �a'!�Au�/�� State License #: P e, 4 O O� CJ � City: �S Zip: ��v`��Expiration Date: ��-- 3 ( -- o�C`�� Phone: ��,�3 — �g 9 --O�5� Alternate Phone: � ��.—3�q-'�'�q d , DETERMINING PERMIT FEES ❑SAC Charge(2013 Rate=$2,435.00) � (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 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 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 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 Permit Requested: $ 2. STATE SURCHARGE $ 5.00 3. POSTAGE& HANDLING (Only on Mail-In 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 ac o ance with �e o 'nances of the City and the regulations of the State of Minnesota, and ce ifie that 1 st � m t made on this application are,true and correct. Appl icant: Date: �(—�� -- �3 SEWER& WATER PCRMIT IN HOUSE FORM - TO HELP DETERMINE SAC UNITS FOR CITY USE ONLY (* Please Key This Information On Comment Line Of Permit*) Dale Completed: #Of SAC Units Completed By: __ ❑ *SAC Previously Paid- Permit# Date of Permit * Chargc 1 SAC Unit Pcr Home * If Multiple liomes Or Units-May Nced"To Pay Additional SAC Charges ❑ ''`SAC Grandfathered In— Permit# Date of Permit * Must havc had Hook Up&Home Prior"I'o January 1, 1973 * Refer to I Iclpful Hint Shcets,Or Ask I1�Necessary * If Multiple Units-May Need To Pay Additional SAC Charges ❑ *Commercial— Permit#Accounted For Date of Permit ❑ *Letter F'rom Met Council—Showing Use-Or Additional Units Nceded- * Contact Jodi at(651)602-1 113 To Obtain Letter(Usually Building OCficial Obtains) * Copies To: Lyle,Street C'ile&One On Copy Of Permit For Reporting * If unablc lo determine;will have to wait to be issucd until determination can bc made ❑ SF',P'TfC Area- *** WATCH I=OR THES[�,CONNECTIONS *** * Nerson Will Havc'l�o Pay Connection Fees&Assessments+SAC Charges * Refer To Current Year Fee Schedule! Don't Release Until P'ees Are PAID! (Ask for Scott or Lin's Help With These) * Will Need Approval Prom Public Warks(Scott) ❑ Special Grinder Pump Needed * Havc'I�hem 1�alk'1'o Scott For Questions&Pricing * Give'I�hcm Special Hand Outs! (In Drawer With Sewer Permit) ❑ Permit Needs Approval From Public Works Approved By: * Side note,Connection Permits—Covcr Septic Tank Abandonment Also,Per Lylc - � � �� i // ��Ci C.ti�� r/ � l�- i� - �� .______.____ _ _ __- ._ . �� - -- -----__----- -----------------_ ___ , < < . _ C _ C',� __ - �� ;�� '�-� � p �� \�' . � � �� a , ' c� ____ `�'�� _ _ _ _ _ _ _ _ _ _-- �fl-� � C��so fv .��s oN l��G .- � la - 3� � -- `�`?�� _ --- _ �`� � � .I �'►� _ ��t P� `^ i f'Yl i�2�c��-�, . _ _ __ I . . I 6'� .�' �-��-�c�.. ��_: �u.�____--�� _- -- . . _��t,�f��i ��-_,__ _�-� ��l�-,t-- . ____.______.�___�!'.�c,� � �n---..__.�/- �..3�-/� _--_______ __._____ -------------__.__ r . , . �------- - _ _ ___ _. �-� f'�� .f c� _ -��C .C_�.�' //-_/.�. -/.� . / �� ?�'�-;�y�� . 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