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Home My WebLink About2014-01279 - sewer/water disconnect L - CITY OF ORONO * Z 0 1 4 - 0 1 2 7 9 * 2750 KELLEY PARKWAY DATE ISSUED: 10/3ll2014 ORONO,MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 3536 LYRIC AVE PIN : 17-117-23-43-0056 LEGAL DESC : NAVARRE HEIGHTS : LOT 000 BLOCK 004 PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION NOTE: SEWER AND WATER DISCONNECT APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 WATER CONNECT/DISCONNECT/REPAIR 50.00 WESTONKA SEWER&WATER STATE SURCHARGE SEWER&WATER 5.00 6501 CO. RD IS MOLJND,MN 55364 TOTAL 105.00 (952)472-4959 Payment(s) Minnesota State License#: BUIL-1804 CHECK 10859 105.00 OWNER HENKE,CHARLES L 3536 LYRIC AVE WAYZATA,MN 55391- AGREEMENT AND SWORN STATEME1vT 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 rype 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 requ' � pections are requested in conformance with the e uii ng Co .This permit may be revoke��any[ime for due ca G� . 3 - / ! /Di i / plicant Permitee Signature Date Issued Signature Date . � _ .. - FOR CITY USE ONLY f�:,,�'-��t City of Orono Date Received: Pern�it# ' � '; P.O.Box 66 � � �iF� i 2750 Kelley Parkway ❑In-House SAC Determination Forn�Completed t � � Crystal Bay,MN 55323 ' ,'"`, � (952)249�600/Fa�c(952)249-4616 Approved By(If Required): L �/;4c;y(�'�'t-, � . CITY OF ORONO—SEWER&WATER/GENERAL PERMIT (*Note:Some permits may require approval by the Building Official and/or Public Works Depamnent') (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoolica6on 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 retum 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 A 1 �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: � ' �-� �e Site Address: ��6 y�'f G i Owner: Mailing Address: City: Zip: Home Phone: Altemate Phone: Contractor-Information: Contractor: W�� S�� Contact Person: 4 �r Address: ��D� �'�� l� State License#: City: 1�Oc,�c� Zip:��' 1 Expiration Date: Phone: �2'�7��I Alternate Phone: ��-�^7�� (?�� , _ _ a DETERII�IlNING PERMTT FEES ❑SAC Charge(2014 Rate=$2,485.00) $ (SAC Charge must accompany all sewer permit applicarions unless prepaid) (Orono City Staff can determine if applicable) (If not prepaid,a sewer connection permit will not be issued) Sewer Connecti n/Disconnect epair($50.00/Per Stub) $ Pipe size inc-�� erial Schd 40 air tested; cast iron ��'t�Vater Connec ' Disconnect/Repair($50.00/Per Stub) $ � �pe size es; 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. This line will be inspected by the Public Works Department. Required 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 $ 5.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ADDITIOI�TAL INFORMATION—�VATER 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 all statements e t ' pplication are,true and correct. Applicant: Date: l��-- / G( 0� DATE TIME CITY OF ORONO CALLED IN INSPECTION NOTI E SCHEDULED PERMIT NO. �� 'a�27 9 COMPLETED //-3 -+Y /4'�-�— ADDRESS 353� C.,y R�L OWNER F• ��'��'�s�r' TELEPHONE NO. CONTRACTOR ��P�� DESCRIPTION -�e��-� fi wi4�R ��s �`'�'�e`� � � FOOTING � PLUMBING FINAL ❑ EXCAV/GRADING/FIWNG Q ❑ POURED WALL O MECHANICAL RI ❑ LAKESHORFJWETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNERIFIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB O WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP O COMPLAINT v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP ? ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL � ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL Z OWNERICONTRACTOR TO MEET YiOU:_YES_NO v�i COMMENTS: � a j 0 �. o� 0 W � Q � 2 W � W � J ��RK SATISFACTORY:PROCEED ❑PROJECT COMPLETE W ❑CORRECT WORK 8 PROCEED ❑ISSUE CERTiFICATE OF OCCUPANCY � ❑CORRECT WORK�LL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑pHOTOTAKEN INSPECTOR WILL REfURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call forthe next inspection 24 hours in advance. (952) 249-46�� pwnerlContra on 'te: Inspector: White Copyllnspector's File Canary CopylSite Notiee