HomeMy WebLinkAbout2017-00107 - sewer disconnect -�
_ CITY OF ORONO * z 0 1 7 - 0 0 1 0 7 *
" 2750 KELLEY PARKWAY DATE ISSUED: 02/07/2017
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 669 MINNETONKA HGLD LA
Pllv : 06-117-23-44-0007
LEGAL DESC : MINNETONKA HIGHLANDS ESTATES
: LOT 003 BLOCK 002
PERMIT TYPE : SEWER
PROPERTY TYPE : RESIDENTIAL
COI�ISTRUCTIOPT TYPE : DISCONNECTION
NOTE: SAC PAID#2819- 1973.
APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00
STATE SURCHARGE SEWER&WATER 1.00
A.L. SHERMER CONST. 1NC. TOTAL 51.00
13451 BALSAM LANE N
DAYTON, MN 55327- Payment(s)
(763)286-0121 CHECK 6813 51.00
Minnesota State License#: SW-PB634960
OWNER
SHIELDS, MICHAEL&MELISSA
800 LANEWOOD LANE N
PLYMOUTH,MN 55447-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable Ciry 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 ifconstruction 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[he State Building Code.This permit may be
revoked at any time for dt�cause.
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Applicant ermitee Signature Date Issued By Signature Date
Feb 03 18 04:34p A.L.Sheremer Const Inc 7632677299 p.1
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1�"'� Cll�Of O7'[i00 ��C�Y'U�ONLI'
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' ��S 2750 Kclley Parkway "
Crystal Bsy,]v�l 53323 �ln-Hoasc SAC Dctcrmiuslion Fmm Cuomoleted
=z'��tcsHo¢``` (952)249-4b00/Pax(952)249-4616 ��' �� + �% ;�,-/-�l� —/f ]7� �
�°�Ppnn'ed HY f�t'R�4uirrd):.
CTTY OF OROI�IQ—SEWER&WA?'ER!GENERAI, � �� `� `\�
PERI�TI'I' �
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(*Note:Some petmits may�ire apprpval by the Build'mg Official end/or Publie Works DcpffitIDent•) ' ' ��
(AX.L PER.__• - Mav be aubfed tu ftMher revirw�nd m�v n� e ic�oed wLen the anol�catin °
p u recernedl.
C'3�J�A�.INF�RMATI�I� � ' - .
1. You may applj,for u�ity p����,����on at ti�e City o�ces. . .
2. Mailed in applications are subject to the pastage�d bandling fee shown below. Pernut cards wil�
be sent by retum mail within 2 business days.
3. Permits are not valid nnt�yoo receive a permit eard,
4. Work must not begi�t uniess the permit card is available on the job site.
5. Utility connecii.on pernnits may be isswed to licensod contra�tors only.
6. Co�act the Public Works Department(952-249-�600)for utility spib as built locations.
DO NaT EXCAVATE IIV ANy STREET AND Dp NpT TAP ANY NIAIN wi�oQt�p�s
s►pproval of the Poblic Works Departmeat. Lssuanc�e�f a peimif does not gaaf�his appray�,
7. All work must be done in accordance vvith S'tate Code rcquiremeWs.
8• All wark must be inspecced before it is covered. Call(952)249-4600,24+haar notice required.
TYf'�Q�PER�i�"I` . ,
Check All'I�t;� 1. .
�Residential(MaY RecNu,e APPz'ovaI) ❑Commezcia,l(Approval R,eyuired)
❑New Connection (]q�dxtiona�eonuectiom []Re-Connection ❑Repa.irs �bDisconnect
❑ Water Availahility Connection Fvr Fttture Hook-Up to Water�-
Jab Site l Ov�er Lu£ar�ataon:
Site Address: I�7�n�.�-Fo n� �-i�I��4 v��5 Lc�v►�
���� Mai.�i.ug Address:
City: Zip:
Home Phone: A]ternate Phone:
co���r�a����: � 1
�.�-., s�e►-l"�er� �or�y�•i��
Contractor: Contact Pezson: �n t�y S�+er+��r'
Address: ����v►�► Gv N state License#�: �(�,��-�1 �C,
C��': c� n �p:� Expiration Date: j���- I "r
���1 �
Phone: �,�� � -{��I Alternate Pbone:
Feb 03 18 04:34p A.L.Sheremer Const Inc 7632677299 p.2
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❑SAC Charge(2015 Rate=$2,485.00) � �
(SAC Charge must accompany ali sewer pern�at applicazions�mless prepaid)
(�rono City Staff can determme if a,pplzcable)
(If not prepaid,a sewer connectien permit will nat be issued)
� �Sewer Connection 1 Disconoect/Repair(SSO.00/Per Stub� s
Pipe size inches;material ' Schd 40 air tested:, cast nrQn
❑Water Conaection!Disconnect/Repair($5p.00JPer Stub} $
Pipe size inches;material Sc�d 40 air testtd; copper
❑Water Availabitity For Future Hook-Up to Water($Sfl.00) $
Water Availabilitv Emlanation•
Contractor instaUed line to inside of house for future hook-up.
T#us lme witl be mspe�ted by the Public Works Depamt�tni.
Required Before Water Counecdon Permit is Issued:
]. Issue Water Meter&Horn Permit
2. Any AdditionaI Conneetion Fees Paid(If Applicable}
Issue Water Connection P it;
1. Collect Permit Fee&Issue Water Connection Perniit
�,., ;
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1. SUBTOTAL of Permit Requested: � �
2. STATE SURCHARGE � �.a0
3. POSTAGE&HANDLING{Only on A�Iai!-In AppIications} $_ � /
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4. TOTAL PERMI3'FEE(Add Lines 1-3 Above) g %,�'
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r.% i i '
An�zTTON�,�a�T�o�v-u�A�R�TERs
� WATER METERS must be picked up and paid for at Orono City Ha1l,these are on a�eparate permit.
■ WAT'ER METEILS must he set and sealed by Orono Water Department (952) 249-4600, upon
completio�o[metcr installatia�.
The undersigned �ereby appties to the City of Orono for issvance of a Utility Pecmit,agrees to da
all work in strict accordance with the ordanances of the City and the regulations of tt�e 5tate of
Minnesoia,and certifies that aIl staiernents made Qn this app�ication are,true and cornect.
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Applican - . Date: 7 �--��
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DATE TIME
CITY OF ORONO CALLED IN �
INSPECTI�N�QT E ��,7 SCHEDULED (�� Q
PERM�T NO. 0 COMPLEfED
ADDRESS n
OWNER TELEPHONE NO. �� �'G O 12.�
CONTRACTOR �`� ���`�`"`� C�'`�
� DESCRIPTION S��'`�'� C��
W ❑ 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 ❑ RATED WALLS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
_
J ❑ DEMO-SITE ❑ SEPTIC INSTALL
? O'WNERIC�I�ITNACTOR TO MEET�11i�0U:_YES_NO
y COMMENTS: � (�U G �L� =`_ '
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�� WOIiK SATiSFACTORY:PROCEED ❑PROJECT COMPLEfE
CORRECT WORK S PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE CONERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑pHOTOTAKEN
INSPECTOR WILL RETURN
❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑INSPECTION REWIRED.CALL TO ARRANGE ACCESS.
Ca11 for the next inspection 24 hours in advance. (952) 249-4600
OMmerlContractor on site: _ I f . : �� ? , �-
Inspector: -�=� ,
White Copyflnapector's File Canary CopylSite Notiee