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Home My WebLink About2016-00696 - sewer/water re-connect � � CITY OF ORONO * Z 0 1 6 — 0 fd 6 9 6 * 2750 KELLEY PARKWAY DATE ISSUED: 06/16/2016 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 3438 LYRIC AVE PIN : 17-117-23-43-0077 LEGAL DESC : NAVARRE HEIGHTS : LOT 023 BLOCK 005 PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : RE-CONNECT NOTE: SAC GRANDFATfIERED IN#3366 10/24/72. ALWAYS CHECK CURRENT MET COUNCIL RECULATIONS. APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 TMS COMPANIES WATERCONNECT/DISCONNECT/REPAIR 50.00 5990 MEADOWLARK LN STATE SURCHARGE SEWER&WATER 1.00 PRIOR LAKE, MN 55372- TOTAL 101.00 (612)414-5700 Payment(s) CREDIT CARD 7702 101.00 OWNER Landsource LLC KOHOUT, JAMISON 550 25TH AVE N ST CLOUD, MN 56303- 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 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 f e cause. � /, � �<-�-. � ��--i<<�� , 1 �� Ap 'cant e ee S�gnature Dat Issued By Signature Date N � •� FOit 1 USE ONL�' ��-��10� City of OCono Date Received: '^ n Permit# _� ��a�' ! •� P.O.Box 66 � �i, I 2750 Kelley Parkway ❑In-Howse SAC Determination Form Completed �� ` \1 �-� Crystal Bay,MN 55323 � �y`\�t.�y�¢j j (952)249-4600/Faac(952)249-4616 Approved By(If Required): 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 further review and mav not be issued when t6e aoolication is receivedl GENERAL INFORMATION 1. You may apply for utility permits by mail or in person at the City of�ices. 2. Mailed in applications aze 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 untii you receive a permit card. 4. Work must not begin unless the pernut 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 approvai 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+6our notice required. TYPE OF PERIVIIT (Check All That A pi ❑Residential(May Require Approval) ❑ Commercial(Approval Required) New Connection ❑Additional Connection 7[�Re-Connection ❑Repairs ❑Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Informati : Site Address: � �� G v� Owner: Mailing Address: City: Zip: Home Phone: Alternate Phone: Contraczor Information: // /( � ' � � i�� Contractor: � � ��K �(C � Contact Person: � Address: �J�/`l��-j��'��tate License#: City: �� Zip:��'�� Expiration Date: Phone: � � �� / Alternate Phone: N � DE'T'ER:N�INTN�i 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 Exnlanation: Contractor installed line to inside of house for future hook-up. T'his line will be inspected by the Public Works Department. Reauired Before Water Connection Permit is Issued: 1. Issue Water Meter&Hom 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 METERS ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a s�arate 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. --_�_ / / Applicant: Date: l�/ ��/ /� DATE TI E CITY OF ORONO CALLED IN INSPECTION NO�E SCHEDULED � 3d PERMIT NO. c``'�'� COMPLETED ADDRESS �7 3� �� OWNER TELEPHONE NO. CONTRACTOR � DESCRIPTION W ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL � ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE 1NSPECTION ` Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS � ❑ INSULATION ❑WOOD BURNER/FIREPLACE ❑ COMPLAINT ' ` Q ❑ FINAL WATER HOOK-UP ❑ FOLLOW-UP i ❑ AS BUILT-SURVEY EWER HOOK-UP ❑ FOUNDATION/REMOVAL J ❑ DEMO-SITE ❑ SEPTIC INSTALL 2 OWNERlCONTRACTOR TO MEET 1I�U:_YES_NO '� � � COMMENTS:T��T u�� (.v�1'� Saf'd�C,�' t,,.(7� � 7V'rAto�-w i�e - o� � 0 � o� 0 � W �� SCl� �l o (�v C s�wU'� s�� Q Z �`'� � ��r � �� ,�`/6 ��r �Sf-' 7�r ��'��/u S � � �A�fORKSATISFACTOR1hPROCEED ❑PRWECTCOMPLETE � ❑OORRECT W'ORK 3 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REtNSPECTION TEMPORARY V BEFORE CONERING PERMANENT ❑CORRECTUNSAFECONDiT10NWffHIN HOURS. �HOTOTAKEN INSPECTOR WILL RETIJRN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call forthe next inspection 24 hours in advance. (952) 249-4600 OwnedContra�tor on site: �U�� -��?S Inspector: �'q � YYhiM CopyAnspecto�'s File Canary CopylSite Notice