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HomeMy WebLinkAbout2013-01206 - sewer/water disconnection � t CITY OF ORONO * z p� 1 3 - 0 1 2 0 6 * 2750 KELLEY PARKWAY UATE �SSUED: 1U13/2013 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2605 KELLY AVE PIN : 20-117-23-14-0022 LEGAL DESC : TOWNS[TE OF LANGDON PARK : LOT 005 BLOCK 005 PERMIT TYPE : SEWER & WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNGCTION N07�E: �L'n"I�ER& SI;WF=,R DISCONNGCTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 BURNS EXCAVATING, INC. WATER CONNECT/DISCONNECT/REPAIR 50.00 3470 CO. RD 21 MAYER, MN 55360- STATE SURCHARGE SEWER& WATER 5.00 (612)685-4303 TOTAL 105.00 Minnesota SCate License#: 1888 OWNER WINE, SC07"1�&JILL 2587 KELLY AVE EXCF.LSIOR, MN 55331- AGREEMENT AND SWORN STATEMENT The work ibr which this permit is issued shall be perfi�nned according to the approved plans and specitications,applicable City approvals,and thc State Building Code. This pemiit is for only the work described and docs not�rant permission for additional or related work which requires scparate permits. All provisions of laws and ordinances governing this rype of���ork shall be compied with whcUicr or not specitied herein.This permit���ill 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. I�he applicant is responsible for assuring all required inspections are requcsted in conformance with the State Building Code.This permit may bc revoked at a�ry time for due cause. -_. l� � l � ��� �'-� ���� ��� .�C��L_ �/i /� i ,� Applicant Permitee Signature Date Issu� By Signature Date SEPARATE PERMITS RF,QUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. FOR CLTY U E ONLY ��7 �j� � � --:.,, Date Received:�� �t# s���� (��J f��i,t'�r`���� City of Orono � � ti P.O.Box 6G [�7n-House SAC Detennination Form Complated � �� 27�0 Kelley Yarkwa}' .:�.i�� � � Crystal 13ay,MN 553�3 p, roved By(If Requiced): — `,, PP \ �r�,-^, (952)249-4600/Fax(952)249-A616 ��.�,r�.��;�,��.,' >:_._.._.- CITY OF ORONO-SEWER& WATER/ GENERAL PERMIT (*Note:Some permits may require approval by the Building OfFicial ancllor Public Works Department*) ALL PERMITS- Ma be sub'ect to Curther review and ma not be issued when the a lication is received) GENERAL INFORMATION - - 1. You may apply for utility permits by mail or in person at the City oftices. 2. Mailed in applications are subject to the postage and handling fee shown below. Nermit cards will be sent by retuin inail within 2 business days. 3. Permits are not valid until you receive a permit card. 4. Work must not begin uuless the permit card is available on the job site. 5. Utility connection permits n�ay be issue�i to licensed contractors only. 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE lN AN�'STREET AND DO NOT TAP ANY A1A1N���ithout express approva!of the Public Works Department. Isstiiance of a permit does not grant this approval. 7. All work u�ust be done in accordance with State Code rec�uirements. 8. All work must be inspected before it is covered. Call (952)249-4600,24+hour notice required. TYPE OF PERMIT _ _ __ _ (Check All That Appl� _ __ -- �'R�sidential(May Rec�uire Approval) ❑ Coinmercial(Approval Renuired) ❑New Connection �Wat r Ava 1 b lrty Conne,tio For�Future Hook-�Up to Water�Disconnect ❑ Job Site/Owner Information: Site Address: %f1'L�`J �L��G U �11������r '' Mailin Address: I�5��`�� ��`j � "�U�'�'` � Owner:�, //L ��ti.�L TTZ LC,��i g -�—�— City: �l��l�l/e��i'�� — Zip: — �`��/�% Home Phone: _ Alternate Phone: _ Contractor Information: Contractor: �(,Ll��l� ��r���1T"1/z� Contact Person: `�7��1/(_- /�GG��/U� , _. Address: ���1�7r� C�-� I�L'� Z� State License #: �/� �����— � Zip:=�.�'(.� Expiration Date: /�/`� City: � Phone: ��Z � "� �3 J� � Alternate Phone: ���Z^ ��� -��^�-� . . , DETERMINING PERMIT FEES � ❑ SAC Charge(2013 Rate=$2,435.00) $ (SAC Charge must accompany all sewer permit applications imless prepaid) (Orono City Staff can determine if applicable) (If not prepaid,a sewer connection permit will not be issued) �ewer Conoectio Disconnect/ epair($50.00/Per Stub) $ Pipe size � hes;ma erial Schd 40 air tested; cast iron —_� ater Connectio /Disconnect/ epair($50.00/Per Stub) $ Pipe size inches;material Schd 40 air tested; copper ❑Water Availability For Future Hook-Up to Water($50.00) $ Water Availability 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 lssued: 1. Issue Water Meter& Hon�Permit 2. Auy Additional Connection Fees Paid(If Applicable) Issue Water Connection Permit: 1. Collect Permit Fee&Issue Water Connection Permit l. SUBTOTAL of Permit Requested: $ 2. STATE SURCHARGE $ 5.00 3. POSTAGE&HANDLING(Only on Mail-ln Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ADDITIONAL INFORMATION—WATER METERS ■ WATER METERS nlust be picked up aud paid for at Orono Ciry Ha11,these are on a separate permit. ■ WATER METERS must be set and sealed by Orono WaYer 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 st�ict 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,true and correct. � Applicant:. Date: �" �.�'l� � S`0� DATE TIME � CITY OF ORONO CALLED IN o INSPECTION NOTICE SCHEDULED �l� : PERMIT NO. COMPLETED ADDRESS a��S ��'� OWNER TELEPHONE NO. ��Z ��5 �303 CONTRACTOR � DESCRIPTION ��� '��s���� � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAWGRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORENVETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB O WATER HOOK-UP ❑ PROGRESS � ❑ FINAL � SEWER HOOK-UP ❑ COMPLAINT � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP � ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL Z OWNERICONTRACTOR TO MEET Y�OU:_YES_NO � COMMENTS: �Qi' G�iS�o��c�v� J� �X fi�e-Us�• a ol.��4-�Le.� iS dt� �,/� s.p Guf Qs-� ?o '' � A-,n�...��-�.�-� Tre .� .�- 7`' � � W %��� �;�i�(!/�l�f 5 �c%� ^7�C� G�il�✓y'�'� Q - �/ �� L'�il�• S�i�79 �Gt/S.2' 2 s����C�CJ+'P.S W � � W � J d W� ❑WORK SATISFACTORY:PROCEED O PROJECT COMPLEfE W ❑CORRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP OR�EH POSTED.CALL INSPECTOR O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. 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