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HomeMy WebLinkAbout2015-00852 - sewer connection CITY OF ORONO * Z 0 1 5 - 0 0 S 5 2 * 2750 KELLEY PARKWAY DATE ISSUED: 07/09/2015 � � ORONO, MN 55356- � (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 1340 FOX ST PIN : 02-117-23-31-0056 LEGAL DESC : MINNETONKA BLUFFS : LOT MB BLOCK 14 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECT[ON NOTE: SAC PAID#6446 09/02/1981 APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 COPPIN SEWER&WATER STATE SURCHARGE SEWER& WATER 1.00 864 QUAIL PKWY TOTAL 51.00 WATERTOWN, MN 55388- Payment(s) Minnesota State License#: SW-57329MR CHECK 4526 51.00 OWNER Chamberlain Capital LLC 11578 CHAMBERLAIN COURT EDEN PRAIR[E, MN 55344- AGREEMENT AI�ID SWORN STATEMENT The work for which this permit is issued shall be performed according ro 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 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 after work has commenced. The applicant is responsible for assuring all required inspections ace requested in conformance with the State Building Code.This permit may be ' � revoked at any time for due cause. ���� ) i . � �� � � /1 • � _" -: '� `. ; _ . ,. �� � � l� -� �� - / / Applicant Permite�Sign ure Date Issued By Sig ature Date � . FOR Y �E ONLY �U/V� Clty of Orono Date Received: � ��ermit# �(!� - �.����):�`' P.O.Box 66 �' 2750 Kelley Parkway ❑[n-House SAC Determination Form Completed , Crystal Bay,MN 55323 �; ".'�„���� (952)249-4600/Fax(952)249-4616 Approved By([f Required): �� ',�u,,�- �= t�C�d �I�NG, `��Z�S 1 CITY OF ORONO—SEWER& WATER/GENERAL PERMIT ' (*Note:Some permits may require approvai by the Building Official and/or Public Works Department*) (ALL PERMITS- Mav be subiect ro further review and mav not be issued when the aaulicallon 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 handiing 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 A 1 � Residential(May Require Approval) ❑Commercial(Approval Required) �C] New Connection ❑ Additional Connection � Re-Connection ❑Repairs ❑Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address: \�3�1[,� t=���c ��- Owner:C,�„�,�,�„y��.r��,.:,� c.��^.�p \ Mailing Address: 1�S��`� �1�.a.:v�bel'�a�y. c�L.. City: 'G-�e,�, flcu:�r:�. Zip: C��'_�y Home Phone: ��;l��O�1,�1,•7 6�3 Alternate Phone: Contractor Information: Contractor: Co��� r� ��,,.,c� � w�,�el Contact Person: �;�� C,�,�p�_ Address: �(��-1 Qti;a,�,�,,c�, State License#: s 73 �.�1 - fti'{3 City: C,,/'u��E-1c,c,.,r� Zip:S.�j' _4�� Expiration Date: \�. � 3�- ��� Phone: �`��- - 5,c� �N�17`-� Alternate Phone: . ' . DETERMINING PERMtT FEES ❑ SAC Charge(2015 Rate=52,485.00) $ (SAC Charge must accompany all sewer permit applications unless prepaid) (Orono City Staffcan deterrr►ine ifapplicable) (If not prepaid,a sewer connection permit will not be issued) � Sewer Connection/Disconnect/Repair($50.00/Per Stub) � Pipe size `t� inches;material�c.�.,4CSchd 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 Availability Exalanation: Contractor instal(ed 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 [ssued: 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 $ 1.00 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 se�aratepermit. ■ 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. 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OWNER TELEP NE NO. l�`���'�� CONTRACTOR � � � � DESCRIPTION c��.x :�'� ��1��'l�'(�1Z�� l� ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING O ❑ 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 _ ❑ AS BUILT-SURVEY �SEWER HOOK-UP ❑ FOUNDATION/REMOVAL v ❑ DEMO-SITE �❑ TIC INSTALL 2 OWNER/CONTRACTOR TO MEET YOU:�ES_NO � / ' (� �� �I `j � COMMENTS:�.��/1 T� it1�� L_ .�l"C%�L^i��' / W a o � �� � ►� �� ISM ���, �/ , �. � 0 � W � Q � 2 W � W � ��WORK SATISFACTORY:PROCEED `RROJ ECT COMPLEf E W ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REtNSPECTiON TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN INSPECTOR WILL REfURN ❑STOP ORDER POSTED.CALL INSPECTOR O CITATION ISSUED O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Ca11 for the next inspection 24 hours in advance. (g52) 249-46Q0 OwnerfContractor on site: � Inspector. White Copyllnspector's File Canary CopylSite Notice