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Home My WebLink About2011-00416 - sewer disconnection *� CITY OF ORONO PERMIT NO.: 2011-00416 �� ° � 2750 KELLEY PARKWAY ORONO, MN 55356- DATE IssuEn: 06/06/2011 952 249-4600 FAX: 952 249-4616 ADDRESS : 1255 DICKENSON ST PIN : 02-117-23-31-0027 LEGAL DESC : MINNETONKA BLUFFS : LOT 000 BLOCK O15 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 BOLLIG& SONS, INC. STATE SURCHARGE SEWER& WATER 5.00 11401 COUNTY ROAD 3 TOTAL 55.00 � HOPKINS,MN (612)938-4433 OWNER DETTLOFF, MARION 1255 DICKENSON ST 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 E3uilding 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 becomc 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 as uri all requjred inspections are �requested in conformance with� ate �t�g Code.This permit may be , revoked at any time f �a .,-:.lL �l v l �/ l l pp icant Permitee Signature Date Issued y Sig ture Date SEPARATE PERMITS REQUIRED FOR WORK OTHER T AN DESCRIBED AB E. .� f + FOR I ifSE ONI:Y �� City of Orono Date Received: E Pe,mit# tZO� "`b P.O.Box 66 2750 Kelley Parkway ❑In-House SAG Detemjination Form Comp'ted ��t 'Y� Crystal Bay,MN 55323 � (952)249-4600 Approved By(If,Required): CITY OF ORONO—SEWER&WATER/GENERAL PERMIT II (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) (.�LL PERMITS- Mav be subiect to further review and mav not be issued when the aunlication is receivedl GENE L 1NFORMATIQN ; 1. ou may apply for utility permits by mail or in person at the City offices. 2. ailed in applications are subject to the postage and handling fee shown below. Permit cards Ilwill l�e sent by return mail within 2 business days. 3. Qermits are not valid until you receive a permit card. 4. �Vork must not begin unless the permit card is available on the job site. 5. � tility connection permits may be issued to licensed contractors only. 6. ontact the Public Works Department(952-249-4600)for utility stub as-built locations. O NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without expr ss approval of the Public Works Department. Issuance of a permit does not grant this approva . 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 requir d. TYFE OF PERMTT ` Check All That A 1 ❑Resic�ential (May Require Approval) ❑Commercial (Approval Required) II ❑ New�onnection ❑Additional Connection ❑Re-Connection ❑Repairs c.�Disconnec � ❑ Water Availability Connection For Future Hook-Up to Water �I Job Site Owner Information: li , /��"5" S�� Srte Add�`ess: r� .� Owner: ,�'7'aw��` � � /�,�" Mailing Address: 7� U<<�t �J; �� City: ��- o'�� L c�. Zip: .S��T�C li Home Phpne: `'7SZ" <<�3 - 3 SL� Alternate Phone: ��2 _ .��3 . I�� `Contracta Inforrnation: Contracto r: /��!/ r�.�.�f Contact Person: �!�� i` �. Address: I S/ / l��i�3 State License#: �� '� ��„� City: i �tif Zip:� Expiration Date: �/a�L Phone: I �.� - 93�y�.33 Alternate Phone: �J�y� 7 ° � .' - + � �� ;°� � ❑SAC Charge(2011 Rate=$2,230.00) $ (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 Connection/Disconnect/Repair($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;materia] Schd 40 air tested; copper ❑Water Availability For Future Hook-Up to Water($50.00) $ Water Availabilitv Exalanation: Contractor installed line to inside of house for future hook-up. This]ine will be inspected by the Public Works Department. Re4uired Before Water Connecrion 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 Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ADDiTTONAL INFORMATION-WATER METERS � f ■ 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 state en mad is application are,true and correct. J � � Applicant: Date: l� ,5 ��' D TE TIME V CITY OF ORONC�--�� CALLED IN �Z I INSPECTION NOTICE SCHEDULED �o �o� PERMIT NO. � �'�� COMPLETED ADDRESS i �� OWNER TELEPHONE NO. � ��73 gQ CONTRACTOR I �` � DESCRIPTION ` � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT v ❑ DEMO-SITE i ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNERICONTRACTOI�TO MEET YOU:_YES_NO c��, COMMENTS: � W a � J O � e'r f ' L�c� `'f �.9� C�P.�l� ° � ` 1 �-�-��,� � Q W � W � � � � W �}p16RKSATISFA�TORY:PROCEED ❑ PROJECTCOMPLEfE � ❑CORRECT WOR�C&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W O �CORRECT WO ,CALL FOR REINSPECTION TEMPORARY V BEFORECOVE ING PERMANENT ❑CORRECTUN FECONDITIONWITHIN HOURS. p pHOTOTAKEN INSPECT R WILL RETURN ❑CITATION ISSUED ❑STOP OROER OSTED.CALL INSPECTOR O IMSPECTION EOUIRED.CAI.I TO ARRANGE ACCESS. � Ca11�or the next inspection 24 hours in advance. (952) 249-4600 OwnerlCont�actor on site• � Inspector. � � hite Copyllnspector's File Canary CopylSite Notice