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Home My WebLink About2017-00328 - sewer connect CITY OF ORONO * z 0 1 7 - 0 0 3 2 8 � 2750 KELLEY PARKWAY DATE ISSUED: 04/06/2017 . . ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 1122 LOMA LINDA AVE PIIY : 08-117-23-23-0026 LEGAL DESC : LOMA LINDA : LOT 000 BLOCK 000 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION NOTE: SAC PA[D#2016-01015 - 10/18/16 APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER&WATER 1.00 COPPIN SEWER&WATER 864 QUAIL PKWY TOTAL S1.00 WATERTOWN,MN 55388- Payment(s) CREDIT CARD 6381 51.00 (612)508-9974 Minnesota State License#: SW-57329MR OWNER BERGH, HANS&SHARON 905 WILLOW VIEW DR LONG LAKE, MN 55356- 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 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 become null and void if construction authorized is not commenced within l80 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 assuring all required inspections are requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. — ��-�J 1 , �� L� L��--� '1 �� '� L/ j/ � !' / /_ �,(:��,...r�. � ? Applicant Permitee Signature Date Issued By Signature Date • �_�....� FUI2 CTI'Y USE ONLY l` �` 'J�' <�, ��10� City of Ol'ono Date Received: t` � �•-� Permit# 7�' �� ' •, P.O.Box 66 �- 2750 Kelley Parkway ❑In-House SAC Determination Form Completed (;� � �' � ,Z-�' Crystai Bay,MN 55323 �(;` \`\\A�.c'�(�j� (952)249-4600/F�(952)249-4616 Approved By(if Required): `;�'�� i ��r` 1�\�l�% CITY OF ORONO-SEWER& WATER/GENERAL PERMIT ��J (*Note:Some pertniu may require approval by the Building Official andlor Public Works Departrnent") (ALL PERMITS- Mav be subiect to further review and mav not be issued wheo t6e aoolicallon is receivedl 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 retum mail within 2 business days. 3. Permits are not valid until you receive a permit card. 4. Work must not begin unless the pernvt card is available on the job site. 5. Utility connection permits may be issued to licensed contractors only. 6. Contact the Public Works Deparnnent(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 1 �Residential(May Require Approval) ❑ Commercial(Approval Required) �New Connection ❑Additional Connection ❑ Re-Connection ❑Repairs ❑Disconnect S�4„��_� ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner information: Site Address: \y��, L,�'� M t,` �=r�1�� fJ�,l� Owner:1� � (, ��L��,..,+.5 Mailing Address: o�t��\�;JM1�.�;��Auz r� City: ,�..'�n�,�.�.�'. s zip: S�`�C`3 C Home Phone: fa\�,�� -�� Alternate Phone: Contractor Information: Contractor: Cc��(;:,. SW„L a-��;al�� Contact Person: �,;�� (`f;�� p�1 �— Address: ��,� 1;c�1.,�►c�T State License#: �i 1��,�R City: �y�s�-�t�A.ci;;� Zip:�43�� Expiration Date: ��1-\� Phone: �C\�.�_ -,� -��l L1 Alternate Phone: D�T��i��PE�IT� - . ❑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 wili not be issued) (�Sewer Connection/Disconnect/Repair($50.00/Per Stuti) $ 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 Ezalanation: 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 Connecrion Permit: 1. Collect Permit Fee&Issue Water Connection Permit 1. SUBTOTAL of Permit Requested: $ 2. STAT'E 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 1�IETERS ■ 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 statements made on this application are,true and correct. r '�Applicant: '(�,�s, C' �,✓�� Date: — (� C�C/' TIMIE � CITY OF ORONO iN � —�, INSPECTION N LED � —/ 7 ,�L(�:.��v PERMIT NO. PLETED ADDRESS � OMINER ` E P ONE NO. CONTRACTO � DESCRIPTION L��L- � ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLIN(3 Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI 0 SITE INSPECTION Q 0 FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS � 0 INSULATION ❑ WOOD BURNER/FIREPLACE ❑COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP i ❑AS BUILT-SURVEY ❑ SEWER HOOK-UP � FOUNDATIOWREMOVAL r � DEMO-SITE ❑ SEPTIC INSTALL i dIMNBYCONTMCTOR TO MEET lf OIY._Y68_NO e— � COMMENT� �� S� O (j'C � � �,,^P � ��1�� S�' �� -�t.c��- � ` 1 o �D�Q, d-C�t! l� M � Z.�id SP�C� �f'' � �',�-c]� . l�l'P� d � e��D _ �e� � � �i( ` dYl A ��'1 Q � W W o� j W ❑WORK SA7ISFACTORY:PROGEED O PROJECT COMPLETE � o oo�cr wo�c a rAocEeo O ISSUE CERTIFlCATE OF OCCUWINC� � ❑COFRECT WOF�C,CALL FOR REINSPECTION TBAPORARY V BEFOpE COVERINO PEpMANBdT ❑(�pqqECTUfd$AFECONOI'TIONWITHIN HOURS. p pHpTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER P08TED.CALL INSPECTOR ❑qTATION ISSUED ❑INSPECTION REOUIRED.CALL TO ARRAN(iE ACCESS. csa�or u�e next r�pecao�u nours�acweno.. (952) 249-4600 Owner�Contraclor on site: Inspeclor: YYhit�CopylM��e�or's FlM �Mry��+