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2016-00921 - sewer connection
P . '. CITY OF ORONO � 0�0 0 9 z 1 * 2750 KELLEY PARKWAY DATE ISSUED: 08/04/2016 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 1830 SHORELINE DR PIN : ]0-117-23-42-0002 LEGAL DESC : AUDITOR'S SUBD.NO. 356 : LOT 000 BLOCK 000 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION NO"1'F,: SEWER CONNGCTION-4"PIPE-PVC MATERIAL APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 COPPIN SEWER&WATER STATE SURCHARGE SEWER& WATER 1.00 864 QUAIL PKWY TOTAL S1.00 WATERTOWN, MN 55388- Payment(s) (6l2)508-9974 CHECK 5013 51.00 Minnesota State License#: SW-57329MR OWNER TUFAA&NEDIYO SADO,TASHITTA 1224 CEDAR POINTE DR N MINNETONKA, MN 55305- 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 rela[ed 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 becon�e 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 required inspections are requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. �' �� 5-�1- I�c ��� � E'�� ��C� �' `�-V. � � � C � i ,� Applicant �rm�tee ignat e Date Issued;B} ignature Date : ; 1 . , ti �0� � City of Orono Date ITaxi�eed. per�ut#Y - a-I � � P.O.Box 66 ; 2750 Kelley Parkway �In-I�onse SAC Det�rmination Fa�m Completed � ,�� Crystal Bay,MN 55323 ��t�'Y[SH�¢�L, �952)249-4G00/Fax(952)249-4616 Approved By.(�'Rtqu�ed�: . . CITY OF ORONO—SEWER&WATER/GENERAL PERNIIT (*Note:Some permits may require approval by tlu Building O�cial and/or Public Works Departrnent') (�.�,PE�$- �'j1V bt lUb�lC1�O fll��r/!VIl�V!�d d1�V�Ot�1t iasnal ah�n fh��nnlin'Hnn ia.,....i....11 GEI'�tE�tAi,INFORMATIOl� 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 cazds 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 permits may be issued to licensed contractors only. 6. Comact 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 ezpress approval of the Public Works Department. Issuance ofa pernut 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 PER1�.tT Check�11 That A �Residential(May Require Approval) ❑Commercial(Approval Required) ❑New Connection ❑Addirional Connection �Re-Connection ❑Repairs ❑Disconnect ❑ Water Availability Connection For Future Hook-Up W Water Job Site/C)vvner inFo.�ation: Site Address: �`� 3 c7 ��zC P\'_,.� (>� Owner:�'a,�,�`�e-- Te�(-'A R Mailing Address: l��LLS`-oce�„ p( City: C1 �1��r, Zip: SS'�°�\ Home Phone: Alternate Phone: �,`a.` �(,9 � ��RO Contractor In�ormation; Contractor: C,e��� 54,��eT�,,,�k( ContactPerson: R`,�� c.o��_,� Address: �(,K c��.:�- �� State License#: �'7 3 ay -M+tZ. City: wn,.1-Q«,x�„� Zip:S�3�� Expiration Date: \'a..-3�� �� Phone: ���.'S�`b-�°11`� Alternate Phone: ,, \ . -� � . . 1 ���1�����'�� ❑SAC Charge(2015 Rate=52,485.00) $ (SAC Charge must accompany all sewer permit applications unless prepaid) (Orono City Staf�'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��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 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 1NFORMATION-WATER METERS ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a senarate 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. 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JPIe'+ �1Ca�:.f�`�Jf''Ir�.,��. _ _ _ �J DAjE,, TIME CITY OF ORONO CALLED IN 7 /(O INSPECTION NOTICE scHEou�En - -/ PERMR NO. o�0/�-OD -`11�/ PLETED '� ADDRESS � �� �=� O'WNER EPH E NO.��Z -SD8'��7� CONfRACTOR � DESCRIPTION 1y ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/(iRADIN(iIFILLIN(3 O ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑TAEE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION � � FRAMING ❑ MECHANICAL FINAL � RATED WALLS � ❑ INSULATION ❑WOOD BURNERIFIREPLACE �COMPLAINT � � FINAL ❑WATER HOOK-UP 0 FOLLOW-UP = O�BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATIOWREMOVAL r ❑ DEMO-SITE ❑ SEPTIC INSTALL � TO MEET 1f0U� Y68_NC � COMMENT� � � �' � � ^ /� // � ° ' s��� �� ov c �—` s�� �.� ° w��7`!� ���o.v- �,��¢ W � Q � W W � �O YMORK SATISFACTORY.PROCEED �RRW ECT COMPLETE W ❑oo�cr wo�c a rRoc� ❑issue corn�►�oFocaiw►Ncr o ❑�CT WOFiK G1LL FOR REINSPECiION TBiPORARY �j BEFORE CWEiUNQ PEAMANBrT OOORRECTUNSAFECONDITIONWITHIN HOUR3. �AKEN INSPECT'OR WILL RETURN O STOP OADER POSTED.CALL IN3PECTOR ❑dTA710N ISSUED ❑INSPECTIOM REQIIIRED.CALL TO ARR/�N(iE ACCES3. caN br u�e ne�ct�specaon u nows in ad�rano.�. (952) 249-4600 on site: � � 1NMN OoV1r��C1��M Gmry Cap�llall�Nolla