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Home My WebLink About2011-00465 - SAC CITY OF ORONO PERMIT 1Y0.: 2011-00465 2750 KELLEY PARKWAY . ORONO, MN 55356- �ATE ISsuED: 06/14/2011 952 249-4600 FAX: 952 249-4616 ADDRESS : 1729 NORTH FARM RD PIN : 27-118-23-44-0018 LEGAL DESC : THE FARM AT LONG LAKE : LOT 000 BLOCK 001 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION NOTE: PER E-MAIL DATED 10/19/2010 BETWEEN MIKE GAFFRON&KARON CAPPAERT AT MET COUNCIL NO SAC SAC CHARGE OF$425.00 WAS PAID IN 1983 E-1 PUMP SEWER CONNECTION-PIPE S[ZE- 1-1/4" SCHEDULE 40 AIR TESTED-MATER[AL-HDPE APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 GROTH SEWER& WATER STATE SURCHARGE SEWER& WATER 5.00 775 TOWER DRIVE TOTAL 55.00 HAMEL, MN 55340- (763)478-6712 Minnesota State License#: 058606-PM OWNER FIELD,MR. & MRS. BENJAMIN 1729 NORTH FARM RD LONG LAKE,MN 55356- 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 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 re nsible for assuring all required inspections are requested in c or ance with the State Building Code.This permit may be ,�" o e t y ' e for due ca e. r � , , , ; � ' C, , , , � Applicant Pe mitee Si ture Date Issu�� By Signature � Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. FQR ITY rSE ONLY ��;"�� City of 01'ono Date Received:� Perniit#p�Q�_� � �O� �O� P�O.Box 66 2750 Kelley Parkway ❑In-Iiouse SAC Determination Fonn Gompleted �i� ��* p �� Crystal Bay,MN 55323 �-r �\� '=� o"' (952)249-4600 Approved E3y(If Required): \\laarsxQ�`� CITY OF ORONO-SEWER& WATER/ GENERAL PERMIT (*Note:Some permits may require approval by the Building Official and/or Public Works Depaitment*) (ALL PERb1ITS- Mav be subiect to further review and mav not be issued when the ann��cation 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 pern�its 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 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: / 7.� �'/ /1� T"i4 ✓'v� (� � Owner: Mailing Address: City: Zip: Home Phone: Alternate Phone: Contractor Information: � Contractor: �j2"f'h S�-��[��s, Contact Person: Address: �7S��W-Q� 1 J-� State License#: -��o� �/yl City: � Zip:S�3�/� Expiration Date: / z-, 3 i �i� 7b 3 �-t� � �� ,-� � Phone: Alternate Phone: �1 2 � 2 S U '��3`�7 S— � , DETERMINING PERMIT FEES ❑ SAC Charge(2011 Rate=$2,230.00) $ (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��chd 40 air tested; � cast iron �1 - P� � c G,a,,,�, b�-✓ ❑ 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 Explanation: Contractor installed line to inside of house for future hool<-up. This line will be inspected by the Public Works Department. Required Before Water Connection Permit is lssued: 1. [ssue Water Meter& Horn Permit 2. Any Additional Connection Fees Paid(lf Applicable) Issue Water Connection Permit: 1. Collect Permit Fee& Issue Water Connection Permit 1. SUBTOTAL of Permit Requested: $ ,J� . � 2. STATE SURCHARGE $ 5.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2•OQ, 4. TOTAL PERMIT FEE(Add Lines I-3 Above) $ �'r�. _�/u 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 certifies th 11 statements made on this application are, true and correct. �� Applicant: � Date: � � �� I `�J✓�" TE TIME CITY ORONO ��E�iN �� INSPECTION NOTICE SCHEDULED � ' d PERMIT NO. O — COMP�ETED ADDRESS � 70� � /l/v��%'`� �GC./y� OWNER TELEPHON N . — O'�395 CONTRACTOR �I� � � � �: DESCRI�TION � 4i ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING � ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS � Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT J ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP _ ❑ DEMO-FINAL �SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI �❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO h � COMMENTS: ,�� .nS/ �r �g ss��✓✓�e$' W C j / � 0 (e 1i'r�vl U��/� /Lv ,SQl�i�''/C �/!��- � � n 0 � M M ,� L✓IVlG� 4 Wr � , � C W � � � GW �WORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLETE � y❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY W 0 ❑ CORRECT WORK,CAIL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT �CORRECT UNSAFE CONDITION WITHIN HOURS. � pHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR � CITATION ISSUED ❑ INSPECTIONREQUIRED.CALITOARRANGEACCESS. Call for the next inspection 24 hours in advance. �952� 249-46�� OwnerlContractor on site: �, Inspector.��'�-� White Copyllnspector's File Canary Copy/Site Notice