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Home My WebLink About2015-00162 - sewer disconnect W � CITY OF ORONO * 2 0 1 5 - 0 0 1 6 2 * 2750 KELLEY PARKWAY DATE ISSUED: 02/09/2015 ORONO,MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 4166 HIGHWOOD RD PIN : 07-117-23-44-0027 LEGAL DESC : HIGHWOOD LAKE MTKA : LOT 033 BLOCK 000 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION NOTE: SEWER DISCONNECT APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER&WATER 5.00 SPECK-TACULAR COMPANIES TOTAL 55.00 5595 270TH STREET E Payment(s) ELKO,MN 55020 CHECK 17082 55.00 n OW1vER WILLOW CREEK,DEV P O BOX 4551 ST PAUL,MN 55104- 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 dces 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 l80 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.1'his permit may be revoked at any time for due cause. / /6 ppp�i Date ssued ignature Date � � �• l��1V� ty —i�og�'Y�U��o ��r Ci of Orono �� rt� P.O.Box 66 i , 2750 Kelley Parkway ❑�-H��o�+Pfi�� , >? Crystal Bay,MN 55323 \'" �� (952)249-4600/Faac(952)249-4616 ��+�H3'��4v}�� \`�KFS ti��/ �+._....._.• CITY OF ORONO—SEWER&WATER/GENERAL PERMIT (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoolicatioo is receivedl GEhTERAL iNFORMATIO�T 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 Depariment(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without ezpress 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. TY�OF PE�t1VITT C��ck 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 �ab 5ite`/O�er�arr��#�rn: Site Address: � r o �''�e��-- �/�'^ a !�"1�" Owner:� C ��7�,. Mailing Address: �/� �S� ��77�,�'l.i �K�y c�ri: Dk��.� �,<<s z�p: .5��'�� /''Z Alternate Phone: �� dZ� H�me rh�nc: � ,�� Co�tta��or I�farrnation: � 3��t 1� Contractor: c� ��w � (..v o,.�s Contact Person: /� Y Address: ��Z�o �,5�•� State License#: ��7�yy� � IZ�3� 1�� City: !� Zip:� Expiration Date: Phone: G�Z .�.� l�.�Z Alternate Phone: � t. ,��" �',��, 1 g s,;'. ❑ SAC Charge(2015 Rate=$2,485.00) $ (SAC Chazge 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 Conn ction/Disconnect/ epair($50.00/Per Stub) $ Pipe size�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 Exulanation: 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. 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 $ 5.00 3. POSTAGE&HANDLING(Only on Mail-In Applicarions) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ AD�TTI�NAL IRTFO�A'T��T-�ATER 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 ce 'fies that all statements made on this application are,true and correct. Applicant: Date: � � � C �/ � DAT TIME1� CITY OF ORONO CALLED IN d— � INSPECTION N TI�,�l�SCHEDULED o2—//� -! �/�r� PERMIT NO. co P�Er ADDRESS l � OWNER LEP ONE NO. �-�^ ��.x CONTRACTOR - J � DESCRIPTION �`�`��J v�-' � S�"!�l�e� ly ❑ 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 ❑ PROGRESS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP kJ ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ HARD COVER REMOVAL J ❑ DEMO-SITE ❑ SEPTIC INSTALL s ❑ FOUNDATION/REMOVAL � OWNERICONTFiACTOFi TO MEET YOU:_YES_NO � COMMENTS: �S�� r��' �-�� ' ��1�1�- C T a �a/�a /c � � � O � � O � W � Q � 2 W � W � J W� �7 WORKSATISFACTORY:PROCEED �ROJECTCOMPLEfE W�O CORRECT WORK 8 PROCEED �❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE CWERING PERMANENT O CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTOTAKEN INSPECTOR WILL REfURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Ca11 for the next inspection 24 hours in advance. (952� 249-4600 � � � OwnerlContractor on site: -� '��` � •'"�=� � � � - �' --:% Inspector. , ."�.; t �. White Copyflnspector's File Canary CopylSfte Notice