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HomeMy WebLinkAbout2017-00580 - sewer & water connection CITY OF ORONO � 0 1 7 - 0 a 5 8 0 * 2750 KELLEY PARKWAY DATE ISSUED: OS/3U2017 ORONO, MN 55356- (952) 249-4600 FAX: (952)249-4616 ADDRESS : 769 BRIDGEWATER DR PIN : 33-118-23-12-0088 LEGAL DESC : STONEBAY SEVENTH ADDITION : LOT 1 BLOCK i PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION NOTE: SEWER AND WATER CONNECTON APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 WATER CONNECT/DISCONNECT/REPAIR 50.00 BOLLIG&SONS,INC. STATE SURCHARGE SEWER&WATER 1.00 11401 COUNTY ROAD 3 HOPKINS,MN 55343- S.A.C. 0.00 (952)938-4133 TOTAL 101.00 Payment(s) CREDIT CARD 9081 101.00 OWNER Wooddale Builders Inc 6117 BLUE CR DR LJNIT#101 MINNETONKA,MN 55343- 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 no[speci6ed 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 180 days at any time after work has commenced. The applicant is responsible for assuring all re ired inspections are requested in c formance wit e State B ' mg Code.This permit may be revoked at y me for due se. � �� �� � �9� �'e� /��/ � Applicant Permitee Signature Date Issued By ' nature Date REC��W�D �1AY 31 2017 �,� J,� �� FOR G'II'1'USE ONLY 4-�N\� City ot Qrono Date Rccei.�ed: Perc►�it � P.O.$ox 66 �++�-�����1��� � � � 2750 Kelley Pazkway r,�,, ❑In-House SAC Detetmination Fom►Completed y „ Crystal Bay,MN 55323 `'�,��C5}"�p�� (952)249-4600/Fax(952)249-4616 Approved By(If Rgquired): __-- CITY qF ORONO—SEWER&WATER/GENERAL PERMIT (*Note:Some permits may require appmval by the Building Official and/or Public Works Department") (ALL PERMITS- Mav be subiect to further review and mav not be issued w6en the aonlicadon is received) GENERAL 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 maii 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,QF P�RMIT 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/Qwner Information: Site Address: �� Gl � �"� �s � �-'`�-�''" � � + � y� A i Owner: W c�aU\ �-` -� Mailing Address: City: ��f`� �� Zip: Home Phone: Alternate Phone: Contractor Information, Contractor: a 1,�r ��� .Sc��-S Contact Person: ,/�'���..-� S��1 � Address: `�`�°� �� e� 3 State License#: �g� y`�`( �3 City: H�p�-;�S Zip:s y 3y3 Expiration Date: ( Z--' 3 �� ��" Phone: `�SL y�� `{��3 Alternate Phone: �� 2 `�3 `� 2y S`i ❑SAC Charge(2016 Rate=$2,485.00) $ (SAC Charge must accompany all sewer permit applications unless prepaid) (Orono City Staff can determine if applicable) C�not prepaid,a sewer connection permit will not be issued) wer 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 Exnlanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Department. Reauired 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 Pertnit Fee&Issue Water Connection Pemut 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) $ ADDITI4NAL INFORMATION '-WATER METE�tS; �` ■ 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 wit he ordinance of the City and the regulations of the State of Minnesota,and certifies that a tatements ma on this ap lication are,true and correct. /� ,� Applicant: ,../ Date: `� " � � ' � � �i�7`� DATE TIME CITY ORONO CALLED IN INSPECTION TICE �� SCHEDULED — — � � PERMfT NO.� —� COMPLETED � ADDRESS � �} �NNER � LEPHONE NO. � �' �"'� ./ � CONTRACTOR � DESCRIPTION N C�� � ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAVlGRADING/FILLIN(i O ❑ 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 i ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL J ❑ DEMO-SITE ❑ SEPTIC INSTALL 2 O�WNEWCOUITpACTOR TO MEET YOU:_YES_NO ' � COMMENT� � Sch� A�� s�,w-er �v�ce � � �6 � �� �cst - � 0 � ° � � � f'� �o�.� r� w�� C .v`�e w. � � _ , Q 7'r•� cQ/ r���.n0_ � W / — � /[1�.�.J �°.c��b s�,� �,�,� —7v �Q f W JQ VMORK SATISFACTORY:PFiOCEED /�ROJECT COMPLETE � � ❑CORRECT WORK�PROCEED ❑ISSUE CERTIFlC/1TE OF OCCUPANCY W p ❑OORRECT WOF11(,CALL FOR REINSPECTION TEMIPORARY V BEFORE(�VERINQ PEFiIiAANENT OCORRECTUNSAFECONDITIONWRHIN HOURS. �p�TOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �GTATION ISSUED ❑INSPECTION REQUIREO.CALL TO ARRAN(3E ACCESS. 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