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HomeMy WebLinkAbout2016-00868 (sewer connection) / . , . ,� � CITY OF ORONO * 2 0 1 6 - 0 0 8 6 8 4 .�, 2750 KELLEY PARKWAY DATE ISSUED: 07/25/201�' ORONO,MN 55356- (952)249-4600 FAX: (952)249-4616 ' ADDRESS : 5 5 KEENE AVE PIN . 2-117-23-31-0027 LEGAL DESC : MINNETONKA BLUFFS :, LOT 000 BLOCK O15 PERMIT TYPE � SEWER PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE % : CONNECTION � NOTE: NEW SEWER COM�ECTION / % � % i' i' / i � i APPLICANT SEWERCONNECT/DISCONNECT/REk�AIR 50.00 STATE SURCHARGE SEWER&WA R 1.00 SITE WO S DESIGN TOTAL 51.00 1225 HWY 169 N. Payment(s) PLYMOU H,MN 55441 CHECK 5746 � 51.00 (763)54 3367 ' / � �� i OWNER H& Development Prtnrshp DE TLOFF,HB&JC � 10 1 TWELVE OAKS CENTER DR#10 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,appiicable City approvals,and the �' State Building Code. This permit is for only the work described and dces j not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances governing this type of work shali 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 iod of 180 days at any time after work has commenced. / The applicant is sponsible for assuring all required inspections are requested in con rmance with the State Building Code.This permit may be revoked at any t' e for due cause. ! _ �� � ��� � � �� � � Applicant P itee Sigr►ature Date Issued By ' �lture Date ' ' ' '� CITY OF ORONO * 20 16 - PJ 868 * 4 .,,,, 2750 KELLEY PARKWAY DATE ISSUED: 7/25/2016 ORONO,MN 55356- (952)249-4600 FAX: (952) 249-4616 ADDRESS � : 525 KEENE AVE i PIN i • 02-117-23-31-0027 � LEGAL DESC � : MINNETONKA BLUFFS : LOT 000 BLOCK O15 I PERMIT TYPE : SEWER i PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE I : CONNECTION NOTE: NEW SEWER CO ECTION I i � I I i � I � I � � i j i IAPPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER&WATER ! 1.00 SITE WORKS DESIC�N TOTAL 51.00 1225 HWY. 169 N. i' Payment(s) j PLYMOUTH,MN 55�441 CHECK 5746 i 51.00 (763)5443367 i' i i i OWNER � H&J Development Prmrshp DETTLOFF,HB&JC 1001 TWELVE O S CENTER DR#10 WAYZATA,MN 5391- i � AGREEM NT AND SWORN STATEMENT � I The work for which is permit is issued shall be performed according to j the approved plans specifications,applicable City approvals,and the State Building Code. This permit is for only the work described and does not grant permission or additional or related work which requires separate permits. All provisi ns of laws and ordinances governing this type of work shall be compied wi whether or not specified hereia This permit will expire and become ull and void if construction suthorized is not j commenced within 80 days of the date of issuance,or if construction is suspended for a p od of 180 days at any time after work has commenced. The applicant is s onsible for assuring all required inspections are requested in con ance with the State Building Code.This permit may be revoked at any t' for due cause. _ �� �� ��� � � �� Applicant P tee Signature Date Issued By ' ature Date I s ~ �A S:y,.i �S 1�L WJ�LX/"`� : ���1-� i�—'�_ � ,F�O/�USE O�'LY.�„l� ��U % ������ Cl Of�r0I10 Date Received� /�Pennit#�U i P.O.Box 66 I 2750 Kelley Parkway ❑In-House SAC Detennination Form Completed �: � ,� ' Crystal Bay,MN 55323 \� � (952)249-4600/Fax(953)249-4616 Approved By(If Required): �kE�SMo�'� �. CITY OF ORONO—SEWER& WATER/GENERAL PERMIT (*M1ote:Some pennits may require approval by the Buildi�g Official and/or Public Works Deparhnent*) (ALL PERMITS- Mav be subiect to further review and ma�•not be issued when the aoolication is received) 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 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 wark must be done in accardance 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) D�New Connection ❑Additional Connection ❑ Re-Connection ❑Repairs ❑Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address: i L 5� 1 i�. � �c�..�_ _ '�>�� .5�.S ���'l���f fi Owner: ? ��` •_�;�,._ �� _:..`� Mailing Address: `( `i.;_ ;t�• ")c��- j K � City: ��._ .�,_ �. Zip: ��j ,.� �. Home Phone: ��� � � �� 3 � �`'� Alternate Phone: Contractor Information: Contractor: `=• �ti��..-•�°;,� �_ . ._ -,_ -,,_: Contact Person: i��.�.� - Address: i' �. 3��r 3��:- State License#: '— s'� � �- City: 1�_-��. Zip:`�:>"S� Expiration Date: �Z� �� Z��1 Phone: � ' � ' ? Alternate Phone: �'. S j 1�� b�� � , . DETERMINING PERMIT FEES ❑ SAC Charge(2016 Rate=$2,485.00) � (SAC Charge�nust 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) ewer 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;material Schd 40 air tested; copper ❑Water Availability For Future Hook-iJp to Water($50.00) $ Water Availabilitv Explanation: Contractar 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: $ ��i v v 2. STATE SURCHARGE $ 1.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ � � ' � 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 Ciry of Orono for issuance of a Utility Permit,agrees to do all work in strict cordance with the ordinances of the City and the regulations of the State of Minnesota,and c ifies that all statements made on this application are,true and correct. L� Applicant: _ Date: �� 2 ) t � • � > r � . : ?� �1rir� CD 1 j� t.;. S� � t , ..� � • � � • " . x t 1� 1"Y.! i. � ..� . . . : . ' .. . ., t • :" • ' y� /' � ^f' �V O T . . ..0.`r ^I t . . .� .� �` '� . .. �,..•- ... . , p a �� �� .: x : .� . . : . . . , :. . . . . . .�_� .. .. .-. � r: � � ' � , a � m : - . . . • .. �4 '. ,. : � : _ : : � ' ' ' . 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CITY OF ORONO—SEWER& WATER/GENERAL PERMIT (*Note:Some pennits may require approval by the Building Official and/or Public Works DeparCment*) (ALI.PERMITS- Mav bc subiect to[urther review and mav not be issued when the application is received) 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 contractars only. 6. Contact the Public Works Department(952-249-4600)for utility stub as-built►ocations. 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 wark 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) �New Connection ❑Additional Connection ❑ Re-Connection ❑Repairs ❑Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address: i Z `�� 1 i� � i�....�_ . '�"i .S a.S ��n����� Owner: Z�.``•��..ti-- �,'� -•��� Mailing Address: `! `r�� ��v�)�z� j (c S City: t�l� �)�.�� Zip: 5��3`P � Home Phone: �.`�� '�� 3 � �`� ? Alternate Phone: Contractor Information: Contractor: `- � �,�.�._._ ,,. ,-�-_ �. ,. -��-, Contact Person: i)��.�� - Address: ��'_ �. 3��r 3��- State License#: �--��S � �-- Ciry: 1��,���. Zip:`��>>''S 3 Expiration Date: �� °� Z�� � Phone: � �L�- ?C� Z �;7� Alternate Phone: (..�S l — )j� b% � - � � 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) ewer 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;material Schd 40 air tested;_ copper ❑Water Availability For Future Hook-Up to Water($50.00) $ Water Availabilitv Explanation: Contractor instailed line to inside of house far 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: $ �Di v u 2. STATE SURCHARGE $ 1.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 a. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ �� ' � 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 Perinit, agrees to do all work in strict cordance with the ordinances of the Ciry and the regulations of the State of Minnesota,and c ifies that all statements made on this application are,true and correct. �1�------ Applicant: Date: ��Z ) ��� � > x � o: x r �7�F►� c � � � ,_ � � � �. . �u � �. � : : : : . g . _,� � ' ' .. °�:. .q... � . . . � t.. . r . , ' . 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T��/ � r ' � o ��� W OC Q � � w � j W �K SATISFACTORY:PROCEED �ROJECT COMPLEfE ����O OORRECT WORK 8 PHOCEED ❑ISSUE CERTIFlCATE OF OCCUPANCY W 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOA/ERINf3 PERMANENT ❑CORRECTUNSAFECONDITIONWRHIN HOURS. ��OTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR ��TAT10N ISSUED O INSPECTION REW IRED.CALL TO ARRANGE ACCESS. CaH for the next inspection 24 hours in advance. (952) 249-4600 Owr�erlCoMractor on site: Inspector: �C.0 White CopyAnap�ctor's Fih Canary CopplSib Nodes Y T TIME CITY OF ORONO CALLED IN 7� / INSPECTION N TI E SCHEDULED /= O� PERMIT NO. ��� co PLETED ADDRESS � � � OWNER TELEPHONE NO.� � � 7� CONTRACTO � DESCRIPTION W�'�`�1 ��'e-��'►'��_ tL ❑ 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 Z J ❑ DEMO-SITE ❑ SEPTIC INSTALL 2 OWNER/CONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: �'�CS y � 7 �( S!'i`i l�D �t/ C a 5��- �e.r W� �e . � � ��� �s�-S/6s �� 1� �.y�,,c�s 0 � W � Q � Z W � W � j d X W� WORKSATISFACTORY:PROCEED j�`RROJECT COMPLEfE ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. �OTO TAKEN INSPECTOR WILL REfURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Ca�1 for the next inspection 2a hours in a ance. (g52) 249-4600 OwnedContractor on site: / ��v Inspector. White Copyflnspector's File Canary CopylSite Notice