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2015-01547 - sewer/water connection
CITY OF ORONO * Z pJ 1 5 - 0 1 5 4 7 * 2750 KELLEY PARKWAY DATE ISSUED: 12/10/2015 � ORONO, MN 55356- ` (952 249-4600 FAX: (952) 249-4616 ADDRESS : 10 MYRTLEWOOD RD PIN : 36-118-23-33-0009 LEGAL DESC : MYRTLEWOOD : LOT 001 BLOCK 001 PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION NOTE: SAC PAID#2015-01198 1 U06/15 APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 WATER CONNECT/DISCONNECT/REPAIR 50.00 COPPIN SEWER&WATER STATE SURCHARGE SEWER&WATER 1.00 864 QUAIL PKWY WATERTOWN, MN 55388- TOTAL 101.00 Minnesota State License#: SW-57329MR Payment(s) CHECK 3315 ]01.00 OWNER Chamberlain Capital LLC 11578 CHAMBERLAIN CT EDEN PRAIRIE,MN 55344- 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 onty 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 a time for due use. � �'� � � �� -�,�/''"V``- � ' � � ��/�s � �1 l��--f� � I� � � �� �� Applicant Permitee Signature Date Issue By Signa e Date y ,� FOR CITY USE ONLY �-� -����^.� City of Orono Date Received: �n'� "/�# � /�J P.O.Box 66 � � 2750 Kelley Parkway ❑In-House SAC Determination Form Completed , � - Crystal Bay,MN 55323 y� � �R.� ��� (952)249-4600/Fax(952)24913616 Approved By(If Required): �1'T� �/,(/� � l CiTY OF ORONO—SEWER&WATER/GENERAL PERMIT J�/� j/S (*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 INFOR.MATION 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 pertnit 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)far 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 wark 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 l �Residential(May Require Approval) ❑Commercial(Approval Required) �,New Connection ❑ Additiona(Connection ❑Re-Connection ❑Repairs ❑Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address: � 6 �T�\Q,������� '(Z'C� Owner: C4��,�,���.('\�:�_r�`�v.\ Mailing Address: ���)� i„��.�,�,��ie�`n c� City: i a.�c n P�,,.; r:� Zip: .�� 3 y� Home Phone: `�S�-�y�'1 f. ��, Alternate Phone: �� Contractor Information: Contractor: C:c��� ��,,� ��;���' Contact Person: �;�,\�j�;� Address: ��l f,ZJcs::\ .�t�..,�� State License#: �513�.�- M�. City: ��}cx1-���,�p_ Zip:� Expiration Date: ��"�\- I(� Phone: 6�a.'.��i-�o1��{ Alternate Phone: + � 'a�� _x �F`�`�'� �.t, ,�;s� �.,r ❑SAC Charge(2015 Rate=$2,485.00) $ (5AC Charge must accompany all sewer permit applications unless prepaid) (Orono City Staff can determine if applicable) (If not prepafd,a sewer connection permit wili not be issned) �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{550.00) $ Water Availabilitv Eaulanation: 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 Pernut is Issued: 1. Issue Water Meter&Horn Permit 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Connection Permit: 1. Collect Pernut 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 PERNIIT FEE(Add Lines 1-3 Above) $ ADDITIONAL INFORMATION—WATER METERS • WATER METER5 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 instaRation. 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 aze,true and correct. ` Date:1 -\� - 1 � Applicant: a�, �.,. ' ,o �� � C �-f- � � � DATE TIME CITY OF ORONO CALLED IN INSPECTION NOTICE SCHEDULED -� b � PERMIT NO. Z7 [; (c�=����7 COMPLETED ADDRESS � � ��/1 J ���I�( F�(`�' -�� OWNER TELEP E NO. � �2 ��'� -C��?� CONTRACTOR � 1 � DESCRIPTION 7C ��� V� C � ty ❑ FOOTING � ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL —T—'�=-4- 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 _ v ❑ DEMO-SITE ❑ PTIC INSTALL 2 OWNERICONTRACTOR TO MEEf YOU:�YES_NO c�.� COMMENTS: � ��! SL'/J �fC% G�U� L� 1�1��� �'���,�� �� D�m � O ,� ' � c �` � --1��1� � � %�1/- �� Z�' �S /�4 i`rv�-��� � �� �! � W � Q � 2 W � W � � J a W RKSATISFACTORY:PROCEED �PROJECT COMPLEfE � ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE CWERING �_pERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. l�PHOTOTAKEN INSPECTOR WILL REfURN /O CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Cail forthe next inspection 24 hours in advance. (952� 249-46�0 OwnerlContractor on site: ���i7�Gt,/ Inspector. �c,l2, White Copyllnspector's File Canary CopylSite Notice ���'�C/+ � DATE TIME CITY OF Oi1ONO CALLED IN �—�'0 —�� INSP�CTION NOTIC SCHEDULED //—/ (o /� PERMIT NO.01�/�D�J��� COMPLETED ADDRESS �� GQ�4 D� OWNER LEPHONE NO. �Z-SD P-`�q7� CONTRACTOR � n � DESCRIPTION �v� ��� �G�'�� -- ty ❑ 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 �NATER HOOK-UP ❑ FOLLOW-UP W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL _ J ❑ DEMO-SITE ❑ SEPTIC INSTALL 2 OWNERICONTRACTOR TO MEET YOU:_YES_NO � , � COMMENTS: ��� `>> �tic:�V' I`f �,,. .: f-�-,, /,,2,�i. r,� . .T1 .y /' ` ` � J � J Y /� �,-t1/ 4��� i I'1.{' " _ `�,? .3.I' ;�(:.''v ,j.�.�..... O � * 4l . �e /�C (� ' h' �t l 1� � � � � W � Q � 2 W � W � � W ��9.WORK SATISFACTORY:PROCEED - �PROJECT COMPLETE � ❑CORRECT VYORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOYERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. '�pHOTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call forthe next inspection 24 hours in advance. (952� 249-46�� i OwnerlContractoronsite: � '� ' -'%� �� inspector._��:r �r ��� _ . � White Copyilnspector's File Cenary CopylSite Notice � � � �' "�6b■ r�a "�'� �` �� ,i ■ � ,�. , � �� � m . ,�' � � i ,l�r'�1 �P ( � ' ��������1� ��II��� � �1' Ili Illi����� 1 '��_� tli(Il.�l _ _ li11�1Uqillli� ����: fi�, ' A r II�iI , � \' -/o -/� �, �. ,,,��� ., _ fi Z s,,,k,�y i� ���'rr� Y-' � i t d� • r � � ��y °";,_�, _w^�4 ��'�. ��.,-_. �/ ������� � � < ♦ 7` '�k.. :. '_� rly. �/ � - _ \� �'TC�1};�.Y� . 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