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Home My WebLink About2015-00681 - sewer disconnect � � � �' CITY OF ORONO * z Q� 1 5 - 0 0 6 8 1 * � 2750 KELLEY PARKWAY DATE ISSUED: OS/29/2015 ORONO, MN 55356- 952 249-4600 FAX: 952 249-4616 ADDR�SS : 945 FOREST ARMS LA PIN : 07-117-23-12-0019 LEGAL DESC : FOREST ARMS COUNTRY CLUB ADDN : LOT 000 BLOCK 002 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION NOTE: SEWER DISCONNECTION APPL[CANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 CHUCK'S EXCAVATING STATE SURCHARGE SEWER& WATER 5.00 760 WEST 96TH STREET TOTAL 55.00 CHANHASSEN, MN 55317- Payment(s) (952)496-2874 CHECK 5262 55.00 Minnesota State License#: SW-L3320 OWNER EATON, BOB&JENNIFER 2721 COMSTOCK LA N PLYMOUTH, MN 55447- AGREEMENT AND SWORN STATEMENT The work for which[his 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 goveming 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 aze requested in conformance with[he State Building Code.This permit may be revoked at any time for due cause. � � � S ^ �� -ls- 5 , 2�, � �� Applicant Permitee Signature Date Issued Signature Date � , • ," F CI USE ONLY / ,-��f-� City of Orono Date Reccived: Pertnit#o?l�t 5-L� �! P.O.Box 66 , 'Y�� ' 2750 Kelley Parkway ❑In-Itouse SAC Determination Form Completed �� , Crystal Bay,MN 55323 � .��,t� � (952)249-4600/Fax(952)249-4616 Approved By(If Required): =-�'ftt�t. CITY OF ORONO- SEWER& WATER/GENERAL PERMIT (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) (ALL PF,RMTTS- Mav be subiect to further review and mav not be issued when t6e aoalication is received) GENERAL INFORMATION 1. 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 untit 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 Deparnnent(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 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: SiteAddress: � !.S ��5�� S l��J Owner: Mailing Address: City: �/�U/l/ G� �'j1� Zip: Home Phone: Alternate Phone: Contractor Information: Contractor: ��!�C kS �X � Contact Person: ✓� Address: ��D W �jL'7�5� State License #: ,� ' ��p City: �hC�.v�/1 �SS �'�`1 Zip:3��f�xpiration Date: ��'�� °- �� Phone: �-�� -�7�� Alternate Phone: �� t�2 �� el�- °1-�� l z � 2S �� '� . , R DETERMINING PERMIT FEES ❑SAC Charge(2015 Rate=$2,485.00) $ (SAC Charge must accompany all sewer permit applications unless prepaid) (Orono City Staff can determine if applicable) (if not prepaid,a sewer co ct' permit will not be issued) �Sewer Connectio /Disconnect/R air($50.00/Per Stub) $ Pipe size�in , r�a 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 Exalanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Department. Rec�uired 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 Pennit Requested: $ 2. STATE SURCHARGE $ 5.00 3. POSTAGE& HANDLING (Only on Mail-ln 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�ermit. ■ 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 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. Applicant: � G�� Date: �� •— �� DAT TIME � CITY OF ORONO CALLED IN �� INSPECTION NOTICE SGHEDULED � PERMIT NO. a��5-�D(oSI COMPLETED ADDRESS OWNER EPHONE NO. Qsa a1�� CONTRACTOR ' C� �; DESCRIPTION `��✓ �� ll� ❑ 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 ❑ PROGRESS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP _ ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ HARD COVER REMOVAL � ❑ DEMO-SITE ❑ SEPTIC INSTALL ❑ FOUNDATION/REMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W a j ��J �C� �1J n�' �j ��n/ �c,c�/ Sc� 0 �' �� lJ t� oL G�,�j �v,P.� o S� � O �'- W �% �!� � SQ.[.✓f'.f✓' r� ��UC'Y al r � � Q 2 � W � W � j d W ❑WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLEfE � ❑CORRECT WORK&PROCEED ❑ ISSUE CERT�FICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE CWERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑pHOTO TAKEN INSPECTOR WILL REfURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Cail for the next inspection 24 hours in advance. (g52 j 249-4600 OwnerlContractor on site: Inspector. �� White Copyllnspector's Ffle Canary CopylSite Notice , �� ..y. �� DATE TIME (\.� CITY OF ORONO CALLED IN INSPECTION TICE. �(Q� SCHEDULED _�1�� . PERMIT NO. � � COMPLETED ADDRESS , �-� ��5� „� OWNER TELEPH NE NO. �v��aL�� a�7y CONTRACTOR ��5 ��C � « � DESCRIPTION � ly ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC F AL 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 ❑ RATED WALLS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP W ❑ AS BUILT-SURVEY ❑ SEWE ,HOOK-UP ❑ FOUNDATION/REMOVAL _ J ❑ DEMO-SITE ❑ S T INSTALL � OWNERICONTRACTOR TO MEET YOU: ES_NO c�., COMMENTS: �—� � � r� �%��/� /n(J�' S'(.%c.c/�'p� �'�"U/�'�'- � � �/ ,�;� y�-S�t �--- �S�/'j�.,�r'� �P.� �/��,� o ` � W 'r / / Q _��/ �� l A)C��lf�.✓ �'ll�d /3 SOL(l9Y' � T� r 2 �/s(��1 E�,G'� t f�e��,�� c� ��D S e;-cJG! �G��'c.�� 7`b � �� ri�i j��c.v--�f ��C�lv �t G �d v� rG�Y��"i,t�al. j �- ��' �' �s� ��i4��P r W WORKSATISFACTORY:PROCEED �ROJECT COMPLETE W ❑ RRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY O O CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECWERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ pf{OTOTAKEN INSPECTOR WFLL REfURN O STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (g52) 249-46�0 i OwnerlContrac o�'on site: � Inspector. � White Copylinspector's File Canary CopylSite Notice