HomeMy WebLinkAbout2016-01347 - sewer connection ' � CITY OF ORONO * Z 0 1 6 - 0 1 3 4 7 *
2750 KELLEY PARKWAY DATE ISSUED: 10/2ll2016
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 3060 FOX ST
PIN : 04-117-23-32-0002
LEGAL DESC : AUDITOR'S SUBD.NO.230
: LOT 032 BLOCK 000
PERMIT TYPE : SEWER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : CONNECTION
NOTE: SEWER CONNECTION AND E1 GRINDER 1NSTALL
SAC PAID ON SAC ONLY PERMIT#2016-01397 10/21/16
APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00
STATE SURCHARGE SEWER&�VATER 1.00
KOTHRADE SEWER&WATER TOTAL 51.00
12059 WHITETAIL AVENUE Payment(s)
HANOVER, MN 55341 CREDIT CARD 9381 51.00
0
Minnesota State License#: plbg-RP645681
OWNER
PARKINSON,TIMOTHY& KRISTI
3060 FOX ST
LONG LAKE, MN 55356-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specitications,applicable City approvals,and the
State Building Code. This pertnit is for only the work described and docs
not grant permission for additional or related��ork which requires separate
pennits. All provisions of laws and ordinances governing this type of work
shall be compied with whed�er 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 arc
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
�
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Applicant ermite ignature Date lssued B i�ature Date
.
[ Y SE ONL II" ]
4�^lO� City of Orono Date Receive ; / Pertnit i{ U/(c !%� �7 /
P.O.Box 66
2750 Kelley Parkway ❑In-House SAC Deterntittation Form Completed
s Z Crystal Bay,MN 55323
`a � (952)249-4600/Fax(952)249-4616 Approved By(If Required):
�KtSHO�'t
CITY OF ORONO—SEWER& WATER/GENERAL PERMIT
('Note:Some permits mny require approval by lhe Building Oflicial and/or Public Works Department')
(AGI.P£R�,tITS- Mav be subiect to Porther review and mav not b�issued when Ihe analication is receivedl
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 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 ANTD DO NOT TAP ANY MAIIY without e:press
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) ���� ���, h��-Qi�l�
Uv«..��
New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect� �,,�.(��/'
❑ Water Availability Connection For Future Hook-Up to Water � �� �1Y�`�u'
Job Site/Owner Information: o�N�� •
Site Address: �Q �f'a X �.
Owner• Mailing Address:
City: Zip: ` � ` .
!�
,�� , �b - .
Home Phone: Alternate Phone: �
Contractor Information: J �
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Contractor: �i�P�rson: v
Address: ���1 ,,,�hc��X.'fCu L�S te License#: ��"!�
( -�,��
City: � Zip:�,�.t. � Expiration Date:
Phone: �((�,t.1�'l0, (\ l�- Alternate Phone:
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DETERMIN(NG PERMIT FEES
❑S��C Ch:irge(201 G Ratc=$2,d85.q0) S
(SAC Char�e must accompany all se�aer permit appiications unless prepaid)
(Orono City Stnf�'can determinc if�applicable)
(If not prepaid,a se�ver connection per►nit��ili not be issued)
�Sewer C:onnection/Uisconnect/Repnir(SSQ.00/Per Stub) S �l 1�O��
�� Pipe size inches:materill Schd 40 air tested; cast iron
❑�ti'�ter Connection/Disconnect/Rep:iir($SQ,00/1'er Stub) $
Pipe size inches;material Schd 40 air tested; copper
❑�V;itcr Av�il:�bility �or Puturc llool:-Up to W.itcr(�SOAO) � _
�Vater Avail.ihilitv Exnlanation:
Contractor installed line to inside of house for future hook-up.
This line will bc inspecte�i by the Public Works Department.
Required t3cforc W�tcr Connection Pennit is Issued:
1. Issue�'Vater Nleter& Horn Permit
2. Any Additinnal Connection Pees Paid(If Applicable)
Issue�Vater Connection Pcnnit:
1. Collect Permit Pee& Issue�Vatcr Connection Permit
l. Slti3T0'T'AL of Permit Requcsted: 5����.-S.l`—'—
2. STAT'E SURCHAIZGG S_ �.�0_
3. POSTAGE�� NANDLII�G(Only on Mail-In Applications) � _2.00
4. TOTAL,PER�it'C F'EE(Add Lines 1-3 Above) 5 ��, Q lJ
ADDITIONAL INr01tM�1TION —WATE{2 METE�RS
■ WATER NIE"TGI25 must bc picked up and paid for at Orono City Hall,these are on a sen�rate permit.
• �VATER VI�'I'ERS must bc set �nd sealed by Orono �Vater Department (952) 249-4G0(l, upon
completion of ineter installation.
Thc undcrsi�ned hereby applies to the City of Oronc� for issu�ince of a Utility Permit,agrees to do
all �vark in striet aecordance with the ordinances of the City and the regulations of tl�e State of
Minnesota. and certifies that��II statements madc on this application are, true and correct.
Applicar : Date:�� (
_ . �- /
v�
DATE TIME
CITY OF ORONO cnLLED IN /�-a�.�
INSPECTION N TICE SCHEDULED l a?-h -/-C� /• '�%
PERMIT NO. '=. G/ -�'/..3��C LETED
ADDRESS �C� (P D �--�i y ��"
OWNER TELEPHONE NO� " 9�' 8 70�
CONTRACTOR G,��Q-�-_
� DESCRIPTION `' �� ��
ty ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
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 ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
_
v ❑ DEMO-SITE ❑ SEPTIC INSTALL
Q OWMERICOI�fTRACTOR�EET YiOIl:_YES_NO
� COMMENTS: � � � V � �' �� �
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�SWORKSATISFACTORY:PROCEED PRWECTCOMPLEfE
W�O�CORRECT WORK 6 PROCEED ❑ISSUE CEFiTIFlCATE OF OCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE CONERIN(i PERMANENT
�CORRECT UNSAFE CONDITION WITHIN HWRS. �,�`pH0T0 TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR O CITATION ISSUED
❑INSPECTION REWIRED.CALL TO ARRANGE ACCESS.
cen ro�n��xt���ro� 4 hours in advanoe. (952) 249-4600
ownerlConvactor on sRe: /" rl�
Inspector. �d�
White CoVYAnspector's FlI� C�nary CopyfSks Notlee
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