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HomeMy WebLinkAbout2017-00458 -sewer/water repair , CITY OF ORONO * Z pJ 1 7 - 0 0 4 5 8 * 2750 KELLEY PARKWAY DATE ISSUED: OS/OS/2017 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 290 CRESTVIEW AVE PIN : OS-117-23-14-0018 LEGAL DESC : BAYSIDE ADDN TO LAKE MINNETONK : LOT 000 BLOCK 001 PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : REPAIR NOTE: REPA[R/MOVING LINES-NO NEED FOR SAC OK'D BY ROGER APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 WATER CONNECT/DISCONNECT/REPAIR 50.00 D.S.M. EXCAVATING STATE SURCHARGE SEWER&WATER 1.00 2916 ENTERPRISE AVE HASTINGS, MN 55033- TOTAL 101.00 (651)480-1355 Payment(s) CREDIT CARD 0444 101.00 OWNER HOCHSTEDLER, SCOTT 290 CRESTVIEW AVE 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 afrer 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. _ � �...1 jZ_. ^�?��i ���`L'^• C- /y'k-�- �;�'/� ��c�� l�� -� � � � i � Applicant Pe�itee Signature � Date Issued By Signature Date . �--� FO�SE ONLY �,� ��� �� ��0�10� Clty Of OCOriO Date Received: Permit# ---��-� �i�i��S �' '�t P.O.Box 66 , � � ; 2750 Ketley Parkway In-House SAC Determination Form Completed (, � �,^ ,�j Crystal Bay,MN 55323 �` �\'t,�x.�s ` F�j (952)249-4600/Fax(952)249-4616 Approved By(If Required): ��'C�� �Acs�i��`j CITY OF ORONO—SEWER& WATER/GENERAL PERMIT (*Note:Some permits may require approval by the Building Official and/or Public Works Departrnent") (ALL PERMITS- Mav be subiect to turther review and mav not be issued when the aualicallon is received) GENERAL INFORMATION 1. You may apply for urility 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 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 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 pl (�Residential(May Require Approval) ❑ Commercial(Approval Required), j�� r�cvi"3 � � ❑ New Connection ❑Additional Connectionn�e-Connection �Repairs ❑Disconnect ❑ Water Availability Co tion For Future Hoo - p to Water Job Site/Owner Information: Site Address: 29d ���►�tL✓ vR-� Owner: 7`Itil ,8�`�'2 Mailing Address: City: d��0 Zip: Home Phone: Gia. ?a�-a9��3 Alternate Phone: Contractor Information: Contractor: t�.S'.�?. �X[A�'.t+��✓���+/L. Contact Person: /,IIkL �d�/1��✓L Address: Z�iL �,��t�i,�� �f�� State License#: City: �11�LS Zip: �33 Expiration Date: Phone: LS� �/�D./3�.f Alternate Phone: lo/� 9/9. y,�y� D�T���@�NI�T�PE�I�'FE�S ❑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 Stuti) $ Pipe size �/ inches;material PVL• Schd 40 air tested; cast iron �Water Connection/Disconnect/Re air($50.00/Per Stub) $ Pipe size�inches;material �0 Schd 40 air tested; copper ❑Water Availability For Future Hook-Up to Water($50.00) $ Water Availabilitv Ezolanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Depariment. , Required 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 $ 1.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ADDITIONAL INFORMATiON-WATER I�IETERS ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a senarate�ermit. ■ 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. Applicant: � Date: ��!�7 . DATE nMe � s i CITY OF ORONO cn���n iN iN8PECT10N NO �J ~ s�Enu�en �-1Z /O: '�'D PERMIT NO. ` r "COMPLETED AuoREss �v OMINER TELEPHONE NO. CONTRACTO , � DESCRIPTION ty ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/(3RADIN(iIFILLINO Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION � ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS � ❑ INSULATION ❑ WOOD BURNERIFIREPLACE 0 COMPLAINT � � FINAL ❑ WATER HOOK-UP 0 FOLLOW-UP W ❑AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATIOWREMOVAL _ r ❑ DEMO-SITE ❑ SEPTIC INSTALL � dwN6YCOK�RAC?�OR TO I�ET YCU:_YES_NO � COMMENT� L�l // '��>�'��-�'�l ,�Q� ���n alt2,��/ 4�-c1�1-�iC/� /9 h L�57�4'fd � 1�'��d a� � �m _�c�/cl► �/��-n 7� '�'�X'► �i�, � ��/ . � �l� �a� � � �� � �' /5��,�.�v� ! 2 Q � W W � j W��YYi0RK3A11SFACTOFiv:PROCEED �RWECf COMPLETE W ❑OORRECT WORK a PROCEED o 1SSUE CERTIFlCA7E OF OOa1PM1NCY o a OORRECT YYON(.CALL FOR RON8PECTION TOiAPORARY �j BEFOqE COVEi�NO PEAMANBVT O(�OFifiECT UNSAFE OOND1710N YYRHIN HOUR3. /,�1(PHOTO TAKEN INSPEC7OR Wlll RETURN �O pTAT10N ISSUED p STOP ORDER P08TED.CALL INSPECTOR O IN8PECT10P1 REGUIRED.C/1LL TO ARRAN(iE ACCESS. c.M Io�u�e next�apection 2�t nows in e�►anos. 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