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2016-00772 - sewer & water repair
'' CITY OF ORONO � * Z PJ 1 6 — PJ 0 7 7 2 * 2750 KELLEY PARKWAY DATE ISSUED: 07/OS/2016 ORONO, MN 55356- (952)249-4600 FAX: (952)249-4616 ADDRESS : 2710 KELLY AVE PIN : 21-117-23-23-0034 LEGAL DESC : VERN-MAR MANOR : LOT 009 BLOCK 000 PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : REPAIR NOTE: WATER REPAIR ONLY APPLICANT WATERCONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER&WATER 1.00 TUMA CONSTRUCTION TOTAL 51.00 5045 COUNTY ROAD 19 MINNETRISTA, MN 55359- Payment(s) (763)479-2982 CHECK 4721 51.00 Minnesota State License#:BUIL-PB695614 OWNER RESTORATION,ROBIN 2080 SHORELINE DR WAYZATA,MN 55391- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifica[ions,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 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 a[any time after work has commenced. The applicant is re onsible for assuring all required inspections are reques d�in co tate Building Code.This permit may be revo `t an ' e for d cause. � _ ��� � �—S= (� � L � � � ?� e_ "[ ;L � � S—� l � pplica Permit Signa ure Date Issued By Signature Date � , �--' FOR CITY USE ONLY ��-��O� City of Orono Date Received:��_����,,, Permit#Z (�/(r;=� ���.�— ;` `•4 P.O.Box 66 �r'� � � ; 2750 Kelley Parkway ❑In-House SAC Determination Form Completed ,��' Crystal Bay,MN 55323 `\`'\�1.�¢i j (952)249-4600/Fau(952)249-4616 Approved By(If Required): - CITY OF ORONO-SEWER& WATER/GENERAL PERMIT (*Note:Some permits may require approval by the Building Official arid/or Public Works Departrnent*) (ALL PERMII'S- Mav be subiect to further review and mav not be issued when the aoalication is receivedl GENERAI,INFORMATION L 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 cazd 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 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 i �] 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: � � � � ���-r- � � y �� '� Owner: Z J � �%-'� � Mailing Address: � City: Zip: Home Phone: Alternate Phone: Contractor Information: Contractor: � �-�^ L�u v�-�-r��LL Contact Person: � f ( �L'�'`'i � Address: -�v�f S ���.-L � {�ou� �4 State License#: � 3 C���CD f �'I City: G� ��H-e-�r,'S E� Zip:s 5�Expiration Date: � Z - 3 cj _ /� Phone: ��Z - C��f`�— S 3 5 S Alternate Phone: . i D�'TE�t���P�T FE� ❑ SAC Charge(2015 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) ❑ Sewer Connection/Disconnect/Repair($50.00/Per Stuli) S 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 Exnlanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Department. � Required Before Water Connecrion Permit is Issued: 1. Issue Water Meter&Horn Permit 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Connecrion Permit: 1. Collect Permit Fee&Issue Water Connection Permit , 1. SUBTOTAL of Permit Requested: $ 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 senarat�rmit. • WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon completion of ineter installation. The undersigned her y applies to the City of Orono for issuance of a Utility Permit, agrees to do all work in strict rdan it tccs-e€-_the City and the regulations of the State of , Minnesota, and fies a all stat ents made on this application are,true and correct. �' Applicant: �z Date: � ` s � �� : 1� �c��- � � � � DATE TIME CITY OF ORONO CALLED IN INSPECTION NOTI E SCHEDULED �� � �ti PERMIT NO. �C��-C�'� 7� COMPLETED ADDRESS � ��C� 1�---e— � �._�-L �-A�_ OWNER TELEPHONE NO. ��' y7%��g�'�- CONTRACTOR c-z rna � � DESCRIPTION )C�-�-� �� � ` CC' /� ' ty ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL C�/ Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING O ❑ FOUNDATION WATERPROOF ❑ PLUMB�NG 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 i ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL v ❑ DEMO-SITE ❑j��EpTIC INSTALL 2 OWNERICONTRACTOR`TO M�YOU:1L YES_NO X c�.� COMMENTS: � a 3 � ` ��, s� J � J / 0 � �1? � 7' �l d Q �=' � T/� �it )'�'U L.l l✓�', ��-!`�� C/1 �/1 O k W � Q z �r C� W � W � j O�❑�WORK SATISFACTORY:PROCEED j�PROJECT COM PLETE W ❑CORRECT VYORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY � BEFORE CdVERING ❑CORRECTUNSAFECONDITIONWITHIN HOURS. PERMANENT INSPECTOR WILL REfURN ��PHOTO TAKEN ❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED ❑ INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call forthe next inspection 24 hours in advance. (g52) 249-46�� OwnerlContractor on site: ��'��� �t:1 L�?� Inspector. �r� �}.�1� White Copyflnspector's File Canary CopylSfte Notice � � � i�„ '�� � « •� � t,' �' -": , � F`! , . n :.,,i�F � � ' . `*' i�� '. � .. ... . � . . } fq a t . + . . �5. . :a-�t"+a� '�t.. n � , �' h y�"i � �• .. .! " . .. - � ` Yt i. 4 � �^t , . � . �� n �• � .�� �� � �B �� � f� �s�'� •�. u^''�.. �ae �� 4� � ' . e +��� .��'�'� °"�,� il�;�,� ; . ��"� ' Y - � , -.- �. � ,_ , . ,� �, .. °�,�r�, 4: �^• - �-- 'a"` � '��. �`5 ,� , . ��:'°'.' �.,'�► � A � `. �� � � ! �z�JF� ' 4� � • � 'E"'� � �., A �" � ,� I`-. .� ��.. �`•� � 'i 1_ .� I 1 r,� . +v� � .. ,44`� � M.+ � * .. ' C �° . � : �..+"Y�. . ` ��: �1.� r ., ` •, . .� . . 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