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HomeMy WebLinkAbout2015-00526 - sewer connect .. CITY OF ORONO * Z 0 1 5 - 0 0 5 2 6 * { 2750 KELLEY PARKWAY DATE ISSUED: OS/04/2015 ORONO, MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 1275 LYMAN AVE PIN : 02-117-23-21-0027 LEGAL DESC : ORONO ORCHARDS HIGHLANDS : LOT 002 BLOCK 001 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER&WATER 5.00 WESTONKA SEWER& WATER 6501 CO. RD 15 S.A.C. 2,485.00 MOLTND, MN 55364 TOTAL 2,540.00 (952)472-4959 Payment(s) Minnesota State License#: BUIL-1804 CHECK 6658 &7: 2,540.00 OWNER MCMILLAN,HOWARD&ELIZABETH 1275 LYMAN AVE WAYZATA, MN 55391- 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[he work described and does not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances governing this rype 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 180 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 f�ie S Building Code.This permit may be revoked at�time for due ausC. �� i� �',- _ _ i /,=� S " % =r ' ` r� — ( � '--�. ._r_�. . ��y���✓1 _5� �I � � s� ._ . �,.% � Applicant Permitee Signature Date Issued By Signature Date � . FOR C T i;,SF.ONI,}, ��;-,��-�-�����. Clty Of�1'On0 Date Reeeived: Permit# �Q �� ��� P.O.Box 66 �� ' 2750 Kelley Parkway ❑In-I Iouse SAC Detennination Form Completed �� �� r , T; Crystal Bay,MN 55323 �`rn�.t��, ' (952)249-4600/Fax(952)249-�616 Approved 13y(If Required): ��:Eti� CITY OF ORONO— SEWER & WATER/GENERAL PERMIT (*Note:Some permits may require approval by the[3uilding Officiai and/or Public Works Deparhnent*) (AI,L PERMITS- Mav be subiect to further review and mav not be issued when the aqplication 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. Permit 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 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. lssuance 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 �esidential(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 / Owner Information: Site Address: �� � �� � �1���-�� � ����-��- � Owner: L ' � � V" `���``� �e✓� Mailing Address: City: Zip: Home Phone: Alternate Phone: Contractor Information: __ � � _�� �� � � Contractor: ��'�`�L•� �`�' �, c.-., Contact Person: �-�d ��� ��� r Address: ��,'( (:�_- . i�1�� � State License #: ;4 City: ��7'�'�`��� `�� Zip:����Expiration Date: .-) , __ � � 1--� y '�� � Alternate Phone: ' Phone: �� " `, � � ' ��� � DETERMINING PERMIT FEES ❑ 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 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 Exalanation: 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 Pern�it 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 Pennit 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) $ ADDITIONAL INFORMATION—WATER METERS ■ 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 cartities that alfi statements made on this application are,true and correct. Applicant:` ,/f�-� � Date: � ' i �� �,� —� DATE TIME CI OF ORONO ALLE IN IN�ECTION NOTICEG ,�.�+-7 SCHEDULED C� -,� PERMIT NO..� I�I'7-"(.lT••iL�O COMPLETED ADDRESS I �� � L l;1 ��f'1 � OWNER TELEPHONE NO. �S�`�7a —�9� CONTRACTOR J .! 1�` ��1fYlkQ � � VlI >; DESCRIPTION ��� ���f1 ly ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ PROGRESS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP _ ❑ AS BUILT-SURVEY �SEWER HOOK-UP ❑ HARD COVER REMOVAL J ❑ DEMO-SITE ❑�PTIC INSTALL ❑ FOUNDATION/REMOVAL 2 OWNERICONTRACTOR TO MEEf YOU: YES_NO � COMMENTS: ` � �� � ��C ,�L/ �� �'�>�:.x'�i � cyl>f�..�_ j �� � � � � � 5 C i' f /�j//�. � - � o � 1 W � � r ,( z _—L�/1 � .� U /�i:.l�� d l. {r �� `7/���' ��r �r W �. �TI� � t�� f �'� ,�. � J W �WORK SATISFACTORY:PROCEED �PROJECT COMPLEfE � ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE CWERINCa PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. O PHOTOTAKEN INSPECTOR WILL REfURN O CITATION ISSUEU ❑STOP OfiDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CAIL TO ARRANGE ACCESS. Cail for the next inspection.2a hours.in advaa�ce. (J52� 249-4600 � OwnerlContractoronsite: �/'ift� G✓i� L�r157�c�,,�✓.f'�` X' �-- � Inspector.�� White Copyllnspector's File Canary CopyiSite Notice � - -��, . v , � �.,y��ac . .� L - ,� �•.. �� - ,.1! . w � . �. • . .. � � � . � /�`�"' Lr1 _41 lF ; d •�� �. .. . ., ;� ��' a,'�'�*cg'; ,� ..�,tlqz+''h�.:A l�.�a .< ��►� �F•,e ��� � � �i �� �a `-'r +�� �: , i R 4����I�i�" � _� , . > , .. ,� � r ' �a � �t � ��- �''q� ` , "`� :�` +�j« ,�kh' 4�. , . � ��'* +� ,� t �'�'�""4` ; , r: �. . �, »�..�q�� ^ � `~#�.' 1 p� �� , i� � ''� yr.y'�.., ` �r l i a .,�u. ���\, � d r� �'Y?• .t� �v� rg' �� ..�:''�' . , ' t.. �...iT i '� '2'!i l,r , . . �''e i���' � � . +� �� c r �� � l� �ti ;:� `*'� ` : �.� � q� ��Z� �.��+ ` . 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