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Home My WebLink About2009-00923 - sewer & water connection ✓ � CITY OF ORONO PERMIT NO.: 2009-00923 2750 KELLEY PARKWAY ORONO, MN 55356- �ATE ISSUE�: 12/3U2009 952 249-4600 FAX: 952 249-4616 ADDRESS : 50 MYRTLEWOOD RD PIN : 36-118-23-33-0006 LEGAL DESC : REG. LAND SURVEY NO. 0446 : LOT 000 BLOCK 000 PERMIT TYPE : SEWER& WATER PROPERTY TYPE : RESIDENT[AL CONSTRUCTION TYPE : CONNECTION NOTE: SAC CHARGF,WAS PAID ON PERMIT#2009-0092113Y HOMEOWNGR-STEVEN CHAMPLIN APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 EARL W. DAY& SONS, INC. WATER CONNECT/DISCONNECT/REPAIR 50.00 P.O. BOX 294 LONG LAKE, MN 55356 STATE SURCHARGE SEWER&WATER 0.50 () TOTAL 100.50 OWNER CHAMPLIN, MR. &MRS. 50 MYRTLEWOOD RD WAYZATA, MN 55391- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specitications,applicable City approvals,and d�e State Building Code. This permit is for only the work described and does not grant pennission for additional or related work which requires separate permits. All provisions of laws and ordinances governing this type of work shall be compied with whe[her 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 I 80 days at any time after work has commenced. The applicant is responsible for assuring all required inspections are requested in conformance wid�the State Building Code.This permit may be re ol�ed at any ir e for due cause. t �. i � �f ` ,J'-G",� .�.. �.3-- / �i ( / L'�" l l App(icant P rmitee Signature Date Issu By Signature Date SEPARATE PERMITS REQUIRED FOR WORK O HER THAN DESCRIBED ABOVE. , ^ FO� TY S ONLY O� 7 ?, O40,�`O City Of OCOIIo Date Received;� ��rmit# ��' ��—� `r P.O.Box 66 q�-, 2750 Kelley Parkway ❑In-House SAC Determination Form Completed � � � r Crystal Bay,MN 55323 ��4�0� (952)249-4600 Approved By(If Required): a'BA08 CITY OF ORONO —SEWER & WATER/GENERAL PERMIT (*Note:Some permits may require approval by the Building Official and/or Public Warks Department*) (ALL PERMITS- Mav be subiect to further review and mav not be issued when the auplication is received) GENERAL INFORMATION 1. You may apply for utility pernlits by mail or in person at the City of�ces. 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. 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+hour notice required. TYPE OF PERMIT (Check All That APPIY) ❑ Residential(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: �L� ��'�U��" �i��L��C;��=�� Owner: �'�. (��1Gt bVl,t��Y'1 Mailing Address: City: ��:Y�Z�' Zip: Home Phone: `17 � -7�`�`� Alternate Phone: Contractor Information: � � (( Contractar: �C� V� � U�`� �� :_�,yt�Contact Person: � ��t'Y��Yl��`'�� Address: ._'�i;� ��i��,�1�11�� - State License #: City: �-i.� 1--�.s��-� Zip:�'�'; �; Expiration Date: c Phone: �lts�- �7� ��E.��-� Alternate Phone: (�:(,,�- �G�-�(� � 1 � :�' �� f� _: ��.�� ' DETERMINING PERMIT FEES '' ��n°� `k-J ��, ❑ SAC Charge(2009 Rate=$2,000.00) $ (SAC Charge must accompany all sewer pernut applications unless prepaid) (Orono City Staff can determine if applicable) (If oot 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 � [��Vater Connection/Disconnect/Repair($50.00/Per Stub) $ ,`7 L- - 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 D,epartment. Required Before Water Connection Pernut is Issued: 1. Issue Water Meter&Horn Pernut 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Connection Perniit: 1. Collect Permit Fee&Issue Water Connection Permit 1. SUBTOTAL of Permit Requested: $ �(�' (.� _ 2. STATE SURCHARGE $ .50 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ �_ 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 se ap rate pernut. ■ 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: , 'Vl.�-�� ; ��;�-t�� Date: ��"�.-( -�� // � �� TE , TIME ►/ � � ' CITY OF ORONO CALLED IN � -=`-`��L' INSPECTIO T CE � SCHEDULED 0 __�� PERMIT NO � �� COMPLETED � �� ADDRESS '�- '�Yj` �: �C � . _ � _ � � _ �_ ., , -- --i7�ivivz°r�"r CONTR. C� I �.0 ;�'1,.1 L TELEPHONE N0. � (� — � f i — V� ` � �.,1.�—tg.s1, ! L� � DESCRIPTION C.{ � ❑ FOOTING � MECHANICAL RI ❑ EXCAV/GRADING/FILLING y ❑ FR,4MING ❑ MECHANICAL FINAL ❑ LAKESHORE/WETLANDS Q ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ TREE REMOVAL Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION Q ❑ FINAL ❑ SEWER HOOK-UP ❑ PROGRESS � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT � ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP _ ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ HARD COVER REMOVAL J ❑ PLU L ❑ FOUNDATION/REMOVAL Z OWNE CONTRACTOR EETYOU: YES ��i,rC�IVI ENTS: ��:J�: 0 � � � ,. �, � y� � J r,� P� ; W � �` �7- Q � '�,' <. � �� ,,�� , � � GW �RKSATISFACTORY: ED �JECTCOMPLETE Wi'��COftRECT WORK&PROCEED �UE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CAIL FOR REINSPECTION MPORARY V BEFORE COVERING PER ENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. � pHOTOTA INSPECTOR WILL RETURN ❑ CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTtON REQUIRED.CALI TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952� 249-46�� erlContractor on site: ,r. 1 � < ��- White Copyllnspector's File Canary Copy/Site Notice