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Home My WebLink About2011-01211 - disconnection CITY OF ORONO PERMIT NO.: 2011-01211 � 2750 KELLEY PARKWAY . � ORONO, MN 55356- �ATE 1SSUED: 10/07/2011 952 249-4600 FAX: 952 249-4616 ADDRESS : 1200 LOMA LINDA AVE PIN : 08-117-23-23-0027 LEGAL DESC : SAGA HILL REVISED : LOT 001 BLOCK 001 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION NOTE: DISCONNECT"11 IE CONNEC"I�ION TO THE COTTAGE ONLY! APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 WESTONKA SEWER& WATER STATE SURCHARGE SEWER& WATER 5.00 6501 CO. RD 15 TOTAL 55.00 MOUND, MN 55364 (952)472-4959 PAID WITH CC# 7464 Minnesota State License#: 1804 OWNER ETAL, EDMUND GRIFFIN 1210 LOMA LINDA AVE MOUND, MN 55364- AGREEMENT AND SWORN STATEMENT "I�he work for which this permit is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the Sta[e Building Code. This permit is for only the work described and does not grant permission for additional or related work which requires separate pennits. All provisions of laws and ordinances goveming this typc of work shall be compied wi[h whether or not specified herein.This permi[will expire and become null and void if construction authorized is not commenced within 180 days of the date of issuance,or if construcfion is suspended for a period of l80 days at any time aYter work has commenced. The applicant is responsible for assuring all required inspections are �� requested in conformance wi he State Building Code.This permit may be � revoked y time fo � c se. -� r �� i �� l � l � / ��C_�( C`�/l�l ('C-�� Y 7- /� App icant Per ' ee ignature Date Issued By S gnature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. . � FOR CITY USF ONLY �� Clty Of�1'Ono Date Received: Permit# P.O.Box 66 �' 2750 Kelley Parkway , In-House SAC Determination Form CompleYed a ��'E� a Crystal Bay,MN 5�323 � �d� � '"�,�o� (952)249-4600 Approved By(If Required): �'4g�BA08 CITY OF ORONO – SEWER& WATER/ GENERAL PERMIT (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) (ALL PERMITS- Mav be subiect to further review and mav not be issued when the application is received) 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. Pernut 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 card is available on the job site. 5. Utility connection pernuts may be issued to licensed contractors only. 6. Contact the Public Works Deparhnent(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 wark must be inspected before it is covered. Call(952)249-4600, 24+hour notice required. TYPE OF PERMIT (Check All That Apply) '�Residential(May Require Approval) ❑ Commercial(Approval Required) �� ❑ New Connection �� ❑Additional Connection ❑ Re-Connection ❑ Repairs � Disconnect i � ��L, ❑ Water Availability Connection For Future Hook-Up to Water V Job Site /Owner Information: �/ �� . / Site Address: �� v��-� �� c��. .��' : / i Owner: �� / S � Mailing Address: City: Zip: Home Phone: Alternate Phone: Contractor Information: —� Contractor: �� `� r� -S! �--' Contact Person: �e�%�%�" C��✓�� Address: �� '� � �� State License#: (�v`�� City: i��`�'�� Zip:�3�� Expiration Date: �-��- 1 / Phone: ci S�� ' ��-�` `��( Alternate Phone: � ��- ��-4�� z , . ❑ SAC Charge(2011 Rate=$2,230.00) $ (SAC Charge must accompany all sewer pemut applicarions unless prepaid) (Orono City Staff can determine if applicable) (If not prepaid,a sewer connection permit will not be issued) �Sewer Connection is /Repair($50.00/Per Stub) $ Pipe size in •-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 Explanation: Contractor installed line to inside of house for fuhue hook-up. This line will be inspected by the Public Works Department. Required Before Water Connecrion Permit is Issued: 1. Issue Water Meter&Horn Pernut 2. Any Additional Connecrion Fees Paid(If Applicable) Issue Water Connection Permit: 1. Collect Pernut Fee&Issue Water Connection Permit l. SUBTOTAL of Permit Requested: $ ,� 2. STATE SURCHARGE $ 5.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ _�� ;` .��,��: � �� ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separatepermit. ■ WATER METERS must be set and sealed by Orono W$ter 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: �—�" /� C��°� C �� r t i��' � -�' ��C`�aS\i�I� ATE TIME ) CITY OF ORONO CALLED IN �� --��-� INSPECTION NOTICE SCHEDULED �' I __`�= PERMIT NO..-��_� I I — C I�� I COMPLETED ADDRESS I ��' C' � (��L � l b'Zc�-C� 1'� "�' OWNER TELEPHONE NO�c� y� � '-'1 CONTRACTOR ��_�-�� Q ` � �'�� ; DESCRIPTION �� L�� SC�I . � � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORFJWETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL ❑ SEPTIC I STALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEP I FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONT�TOR TO MEEf YOU: YES_NO � COMMENTS: � W a � � o �-� n �t .�- ��O ��r`�- a � � �O r �� L U � Q ti Z W � W � � d W ❑WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE � ❑CORRECT WORK&PROCEED r ISSUE CERTIFICATE OF OCCUPANCY W 0 ❑CORRECT WORK,CAIL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ PHOTOTAKEN INSPECTOR Wl�L RETURN ❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED ❑ INSPECTION REQUIRED.CALLTOARRANGE ACCESS. Call for the next inspection 24 hours in advance. �952� Z49-4600 OwnerlContractor on site: Inspector. White Copyllnspector's File Canary CopylSite Notice