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Home My WebLink About2016-01429 - sewer/water disconnect CITY OF ORONO * z 0 1 6 - a 1�� 2750 KELLEY PARKWAY DATE ISSUED: 1ll14/2016 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 3295 CRYSTAL [3AY RD P I N : 17-117-23-4 I-0013 LEGAL DESC e TOWNSITE OF LANGDON PARK : LOT 002 BLOCK 002 PERMIT TYPE : SEWER&WATER PROPERTY TYPE e RESIDENTIAL CONSTRUCTION TYPE a DISCONNECTION NOTE: DISCONNECT ONLY APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 WATI:RCONNECT/D[SCONNECT/REPAIR 50.00 SCHERBGR COMPANY, LLC STATE SURCHARGE SEWER&VVATER 1.00 20160 75TH LANE N CORCORAN,MN 55340- TOTAL 101.00 (763)497-1100 Payment(s) CHECK 17580 101.00 OWNER GREG BLASKO, WHI"['NEY WINDMILLER 3295 CRYS'I'AL BAY RD WAYZATA. MN 55391- AGREEMENT AND SWORN STATEMENT 'Che work for tihich this permit is issued shall be perfomied according to the approved plans and specitications,applicable City approvals,and the State E3uilding Code. This permit is for only the work dcscribed and does not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances governing diis type of work shall be compicd 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 are requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. —__ ��> _—_.___f.._...,_--...__.. �' � 1 -- � �-�� (� C�/) ��-^�--� 7`z� Z-' ��/ �4�/ �� Ap icant Permitee Signature Date Issued I3y Signature Date . ,. -� FOR CTI`Y U�E ONLY ��NO�� City Of Ol'ono Date Received: ///� Pemzit# �c(� �(,oz C� � � P.O.Boz 66 ; 2750 Kelley Parkway ❑In-Hoese SAC Determination Form Completed �i� � Z-�' Crystal Bay,MN 55323 _ d `\`'� .�'� F�f (952)249-4600/Fax(952)249-4616 Approved By(IfRequired): dj�//tpC=�" '�'�is�io�'j —_____•- CITY OF ORONO—SEWER& WATER/GENERAL PERMIT (*Note:Some permiu may requ've approvai by the Building Official and/or Public Works Departrnent') (ALL PERMTI'S- Mav be subiect to further review and mav not be issued wLen the aoolication is receivedl GENE�tAL IIVFORI+�ATION 1. You may apply for urility permits by mail or in person at the City offices. 2. Mailed in applications aze subject to the postage and handling fee shown below. Pemut cards will be sent by retum mail within 2 business days. 3. Permits are not valid until you receive a permit card. 4. Work must not begin unless the pemiit card is available on the job site. 5. Urility 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 PER1vI�T' Check All That A 1 I.�f Residential(May Require Approval) ❑ Commercial(Approval Required) `1` ❑ New Connecrion ❑Additional Connection ❑ Re-Connection ❑Repairs �Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Orvner Ir�orrnation: f r ' Site Address: ��S L- l'��.��i.': ; 1 .�.,=� � �-''� Owner: �� !;,.�� ,^�-�.�- '� Mailing Address: 'I �(b /l;r.. ��`,� r� City: I}l�`.�,,T�%� Zip: 53�� ..7 Home Phone: ��R.� �� S� I �l�L� Alternate Phone: Contractor Information: �. /� � � ) Contractor: �C' f �-t � tn-� .' � �� Contact Person: �_l�I �i. ; 1 �r ��j..� ,�- Address: J"C�� l� 7�� ``` State License#: City: `-�"< <' � �� Zip:�-�`/p Expiration Date: '? Phone: -�/�� .�-7 `�r�� 7 Alternate Phone: , D�'TERIU[Il��P�RMIT FEES � ❑ SAC Charge(2015 Rate=52,485.00) $ (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 Connectio /Disconnect epair($50.00/Per Stuti) $ ��` • �� Pipe size inches;material Schd 40 air tested; cast iron ❑ Water Connection Disconnect •Repair($50.40/Per Stub) $ �� Pipe size inches;ma enal Schd 40 air tested; copper ❑ Water Availability For Future Hook-Up to Water($50.00) $ Water Availabilitv Eanlaaation: Contractor installed line to inside of house for future hook-up. T'his line will be inspected by the Public Works Department. RecLuired Before Water Connection Permit is Issued: 1. Issue VJater Meter&Hom Permit 2, Any Additional Connection Fees Paid(If Applicable) Issue Water Connection Permit: 1. Coilect Permit Fee&Issue Water Connection Permit 1. SUBTOTAL of Pernut Requested: $ L�� 2. STATE SURCHARGE $ ].00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �V�S- '� 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 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: Date: ��1�� G�� DA E TIME CITY OF ORONO CALLED�N / -� INSPECTION NOTI E SCHEDULED l/-!S -/b PERMR NO. ��-�� 2� COMPLETED ADDRESS -� �5 � S' �� OWNER TEL�ONE NO. CONTRACTOR SL �E� - � DESCRIPTION -� ��N �� l�y ❑ 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 � ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP 41 ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL _ J ❑ DEMO-SITE ❑ SEPTIC INSTALL ? OWNERlCONTRACTOR TO M��T YOU:T YES_NO ., � COMMENTS: `y ��/9��E'�.�t�v�l" ��''�'"�/�y C�V,�c� � o �� Dr-�n c-:� 1..�� -L°i CsL �. � r � � 0 W � 2 ��l a� � W � � J W ❑WOIiK SATISFACTORY:PFiOCEED ❑PROJECT COMPLEfE � ❑OORRECT WORK 8 PROCEED ❑ISSUE CERTIFlCATE OF OCCUPANCY W O ❑CORRECT NfORK,CALL FOR REINSPECTION TEMPORARY V BEFORE CdVERINO PERMANENT ❑CORRECT UNSAFE CONDITION WRHIN HWRS. p pHpTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REOUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (g52) 249-4600 OwnedContractor on site: �C%�/'��.s �� S Inspector. �C'�%7� White Copyllnapector's Fils Canary CopylSib Notics