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Home My WebLink About2016-00432 - sewer connection 4 CITY OF ORONO * Z 0 1 6 - 0 0 4 3 2 * � 2750 KELLEY PARKWAY DATE ISSUED: 04/26/2016 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 1495 GREEN TREES RD PIN : 11-117-23-23-0012 LEGAL DESC : GREEN TREES ON TANAGER LAKE : LOT 002 BLOCK 001 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCT[ON TYPE : CONNECTION N07'E: SAC PAID#4425 02/18/91 APPL[CANT SEWERCONNECT/DISCONNECT/REPA[R 50.00 STATE SURCHARGE SEWER&WATER 1.00 PATNODE BROTHERS INC. MAIL-IN FEE 2.00 2841 LANDER AVE ST. MICHEAL,MN 55376- TOTAL 53.00 (612)919-0112 Payment(s) Minnesota State License#: sept-L3843 CHECK 3350 53.00 OWNER BRASS, JAMES&JUDITH 1495 GREEN TREES RD WAYZATA, MN 55391- AGREEMENT AND SWORN STATEMENT The work for which this 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 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 l80 days at any time after work has commenced. The appiicant 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. � �T��) � �\L`� � '� ��.�..�t ��1.1 / � � i � z�. ' ` U� z �- � Applicant Permitee Signature � Date� Issued By Signatur� Date ' � /, i i. �i - - ,I f/ L - r'��= � r� �� ,,,r-� l,��t f ,•y�� ; / �z% ��1��,;1 �_�-��.,«��< .��;� /�:�� -.. .� f FO C��SE ONLY -1��N�� City of Orono Datc Reccived: Pcrmit# ��n^ �� P.O.Box 66 1 2750 Kellcy Parkway �In-House SAC Determination Form Completed � � Crystal Bay,MN 55323 �� `•``�.1 ±'�,,'-� (952)249-4600/Fax(952)249-4616 Approved By(If Required): n,.,,,,� � zll�Ja� CITY OF ORONO— SEWER & WATER/GENERAL PERMIT (�Note:Some permits may require approval by the Building Ot�icial and/or Public Works Departmcnt*) (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoulication is received) GENERAL INFORMATION l. You may apply for utiLity permits by mail or in person at the City offices. 2. Mailcd in applications are subject to the postage and handling fee shown below. Permit cards will bc 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. issuancc 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 l ) �sidential (May Require Approval) ❑ Commercial(Approval Required) New Connection ❑Additional Connecrion ❑Re-Connection ❑ Repairs ❑ Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address: �t��.7 CS/'P�� { i r� E, /�c�/ Owner:��`r►-► C�r'tr.� Mailing Address: ��-��--� City: L��l"anc� t�r1 n/ �i Zip: -� ��y� Home Phone: ��S�� (p �f�Z y Alternate Phone: Contractor Information: � r Contractor: l��tf�� J'c�f/��/.5 Contact Person: �1ik v'�'t1 ��c�r r''f Address: Z f��l/ L ccr�c/P/',�� /1/r State License #: L--...�t,�S13 City: i�� Zip:�� Expiration Date: 5 5;3 7(� Phone: (�(.� �)/�j �//�— Alternate Phone: j DETERMINING PERMIT FEES ❑ SAC Charge(2016 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 connection permit will not be issued) t^� Cr� ewer Connection/Disconnect/Repair($50.00/Per Stub) $ ��J� Pipe sizc 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 Explanation: 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. lssue Water Meter&Horn Permit 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Connection Permit: 1. Collcct Permit Fee&Issue Water Connection Permit �—/1 t� 1. SUBTOTAL of Permit Requested: $ � (� 2. STATE SURCHARGE $ 1.00 3. POSTAGE& HANDLING(Only on Mail-In Applications) $ 2.00 G� 4. TOTAL PERMIT FEE (Add Lines 1-3 Abovc) $ �� ADDITIONAL INFORMATION— WATER METERS ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a senarate 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, truc and correct. � � ��-�� Applicant ��...� �� Date: 1� �.- �� DATE TIME CITY OF ORONO CALLED IN 7-2�" lh INSPECTION NOTICE �,'/.� SCHEDULED S - 1 - 1 S� 3:� PERMIT NO. �l�v-(�J� COMPLETED ADDRESS �� 5 � OWNER —T LEPHONE NO. ��Z��v��'� CONTRACTOR � S � ✓� � DESCRIPTION �4�� - `- / � ��' � n � � lu ❑ 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 W ❑ AS BUILT-SURVEY /{] SEWER HOOK-UP ❑ FOUNDATION/REMOVAL = t v ❑ DEMO-SITE '� ❑ SEPTIC INSTALL 2 OWNERfCONTRACTOR TO MEET YOU:_YES_NO y COMMENTS: �`�' ` � � � �/� � J O � a� t °o � , � � d �- Q e�l� � r ,�l - / • s � � .�� S � s.�l � � // � w � _ � WORK SATISFACTORY:PROCEED �P�ROJECT COMPLETE d � ❑ RRECT VYORK 6 PROCEED �`ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING �/' PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. J�PHOTOTAKEN INSPECTOR WILI REfURN � ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspecY 24 hobrs in advance. (g52) 249-4600 OwnerfContractoron site: ,� . Inspector. White Copyllnspector's File Cenary CopylSfte Notice