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2013-01237 - sewer connect
�. , CITY OF ORONO * 2 0 1 3 - 0 1 2 3 7 * 2750 KELLEY PARKWAY DATE ISSUED: 11/22/2013 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 : CONNECTION NO"rL: NGW SEWER CONNrCTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 OUVERSON SEWER& WATER STATE SURCHARGE SEWER& WATER 5.00 P O BOX 247 LORETTO, MN 55357- TOTAL 55.00 Minnesota State License#: MR86668 OWNER TRUWIT, CHIP l]OS FERNDALE RD W WAYZATA, MN 55391- AGREEMENT AND SWORN STATEMENT The N�ork 1or which this permit is issued shall be performed according to the approvcd plans and specifications,applicable City approvals,and the State Building Code. This permit is for only the work deseribed 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 it�construction authorized is not commenccd within 180 days of the date of issuance,or if construction is suspended ibr a period of 180 days at any time after work has commenced. The applicant is responsible for assuring all requircd inspections are requested in conformance with the State Building Code."I�his permit may be revoked any time for due cause. ,� "- i ' i / � l/ �2 ;- "�� r i�o� %3 Ajrplican ermitee Signaturc Date ���� �Iss e y Signature � Date r SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. � . � � � � FOR CIT USE ONLY ,���/�/�-, City of Orono Date Received: �Perniit# .�L/ i'G ✓Z zj� P O. Box 66 l �' 27�0 Kelley Parkway ❑ In-House SAC Detefmination Form Comple[ed , i , , Crystal Bay,MN 55323 '�,� Y�!�t�= (9�2)249-4600/Fax(952)249-4616 Approved By(If Required): .tiii., CITY OF ORONO - SEWER & WATER / GENERAL PERMIT (*Note:Some pennits may require approval by the Building Of�ficial and/or Public Works Department*) (ALL PERi�II"I'S- Mav be subiect to further review and mav not be issued when the application is received) GENERAL INFORMATION I. You may apply for utility pennits by mai(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)for utility 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 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 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: ��V S /�`�"`��`'��le �� � Owner: �G'/,� ��`�`-" "'� Mailing Address: City: Zip: Home Phone: �� L �L s ,�9S� Alternate Phone: Contractar Information: ,�) Contractor: ��f u�5�� S�"� � �`�ontact Person: / �' y •- —�—� Address: �° ��h 2 y 7 State License #: /`�� �6�� �� City: ��"� �'�'' Zip:553�7 Expiration Date: / � �`/ Phone: � �L 7 S �- ��`�g Alternate Phone: � - 1. 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 y� 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 Esplanation: 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 1. 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, agcees to do all work in strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that all statements made on this application are, true and correct. 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'� ,� �. _ �� � ���'�s.y , . :� "1�' �' I I .;y � y�" � �r /� y� Y \ y,�a� 4 , . \ � ,�y, , ,c . ,. � . �.. � x. �� � � � �, - � -�'�'�" � ' � - , � ��� � �i�J a".� �� : : � ,. ..A. . . . s ��� . , � R. � ������ � � DATE TIME ✓ CITY OF ORONO CALLED IN INSPECTION NOTICE SCHEDULED PERMIT NO.�3� ���3� COMPLETED %l -Ll,-/3 c�SiS' ADDRESS /�C 5� �T�'f��i41e � � OWNER TELEPHONE NO. CONTRACTOR ���-✓�� �'''�' j DESCRIPTION S�'tUe�' C�Gi�/���j� .�, � � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL O MECHANICAL RI ❑ LAKESHOREM/ETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL 2 ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT r ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNERfCONTRACTOR TO MEET YOU:_YES_NO c�.� COMMENTS: �`�/�`� "�%r /�/�>z .�� �'4-/��� � W a J SZ'� �'� � �� S f'�5��� ��c/C — �� � D� 0 � L���d y " c.�s � �-�-�.�, � ��.��,�;�. 0 � W � Q � 2 W � W � J d � WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE � ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WOFK,CALL FOR REINSPECTION TEMPORARY � BEFORE CWERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pHOTOTAKEN INSPECTOR WILL REfURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 2a hours in advance. (952) 249-4600 _ OwnerlContractor on site: ��U�✓j�` � —S�zJ/'r� �r�'✓���'��� � Inspector. = �, White Copyllnspector's file Canary CopylSite Notiee