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2017-01142 - sewer connection
CITY OF ORONO *�� _ 0 1 1 4 z * 2750 KELLEY PARKWAY DATE ISSUED: 09/18/2017 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 3017 NORTH SHORE DR PIN : 09-117-23-32-0002 LEGAL DESC : CORONADO BEACH LK MTKA : LOT 000 BLOCK 000 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION NOTE: SEWER CONNECTOIN APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER&WATER 1.00 SCHERBER CO. LLC 20160 75TH AVE N TOTAL 51.00 CORCORAN,MN 55340- Payment(s) (612)282-7403 CHECK 18073 51.00 OWNER BLUE,JAMES 9610 SKY LA EDEN PRAIRIE,MN 55347- 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 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 wi[hin 180 days of the date of issuance,or if construction is suspended for a period of 180 days at any time afrer work has commenced. The applicant is responsible for ass ring all required inspections are requested in conformance with State Building Code.This permit may be revoked at any time for d se. � � � �Sv 9 �/ �'�/� App ' ant rmitee Signature Date Issued Signature Date �()R CITY rtl�,OT�LY ���0�� City Of Orono Date Recei�ea: Per�it# ; P.O.Box 66 � f 2750 Ke(Icy Parkway �7n-�o�se SAC Dectrminatioa Form Complcted �, ,�� Crystal Bay,MN 55323 \�[sH oQ'kL` (952)249-4600/Fa�c(952)249-4616 Approved BY(IYRequirod): CITY OF ORONO—SEWER&WATER/GENERAL pERMIT (`Note:Some peamits may require apProval by the Building Officiffi and/or Public Works Departrnprt s) (ALL PERMITS- 11iav be snbi tn fn'fh�r ervi�!pa maV�Ot I/2 i"s.ued��hen the aoo;;� tinn ix h�w� GfiI�TE�tAL INFORMATIOI� 1. You may apply for utility permits by maii 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 rehun mail within 2 business days. 3. Permits are not valid until yoa receive a permit card. 4. Work must not begin unless the permit card is available on the job site. 5. Urility connection permits may be issued to licensed contractors only. 6. Contact the Public Works Department(952-249-4600j for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without eapress 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,Z4+t�our notice required. TY�E OF PER.�T Check All That A i, . ❑Residential(May Require Approval) ❑ Commercial{Approval Required) �New Connection ❑Additional Connection ❑Re-Connection ❑Re airs P ❑Disconnect ❑ Water Availability Connecrion For Future Hook-Up to Water Jo� Si�e/Owm�r Info�ation: /`�, i<� C �w�-„s��:, (-�''�c S (` �� S��-1 yP8 Site Address: �� �� �d Q f th Sh�;2 ,D�. Owner: Mailing Address: City: Zip: Home Phone: Alternate Phone: Contractor In;formation: Contractor: Sc �z:�z �" �,o..�p. Contact Person: _�,-�� Address: �� ��� �5 �� a"t �'r State License#: City: C�r��r��n Zip: 5S3yo Expiration Date: Phone: ,'r6 �t? 1�� � 7y��� � � Alternate Phone: D�'I'F,.��3�PET�+�I`�'FF� : ❑ SAC Charge(2015 Rate=52,485.00) $ (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 Stuti) $ !' Pipe size inches;material Schd 40 air tested; cast iron ❑Water Connection/Disconnect/Repair(550.00/Per Stub) $ Pipe size inches;material Schd 40 air tested; copper �Water Availability For Future Hook-Up to Water($50.00) $ Water Availabilitv Eaulanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Department. � Re uired Before Water Connection Permit is Issued: 1. Issue VJater Meter&Horn Permit 2. Any Additional Connection Fees Paid(If Applicabie) Issue Water Connection Permit: 1. Collect Permit 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 PERMIT FEE(Add Lines l-3 Above) $ ADDITIONAL INFORMATiO3�1-WATER 1�IETERS ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a senarate 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 that all statements made on this application are,true and correct. �z:"�vt..� �r t�S Date: `�1 �� �� Applicant: , � DATE TIME CITY OF ORONO cnLLED IN � .T_ INSPECTION TICE HEnuLED `� PERMR NO. l � COMPLETED ADDRESS �JD/'7 N- �`1_�- �1'�� OWNER TELEPHONE NO. l - g��71� CONTRACTOR � � � DESCRIPTION ����-n'�C-' �-r�n.- ty ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING O ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT � ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL _ � ❑ DEMO-SITE ❑ SEPTIC INSTALL 2 OMINERICOKTRACTOR TO MEET Y�U:_YES_NO � � COMMENTS: �''�� � / j � r"/! S ,�> >5���v��� �� U� 0 W 0C Q F� W W � � , ��UMORK SATISFACTORY:PROCEED PRW ECT COMPLEfE � O CORRECT WORK 8 PROCEED ISSUE CERTIFlCATE OF OCCUPANCY � �CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE CONERINO PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. pf{pTOTAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR GTATION ISSUED ❑INSPECTiON REW IRED.CALL TO ARRANGE ACCESS. Cafl for the next inspection 24 hours in advance. (952) 249-4600 Owne�Contractor on site: � �+" ,� y Inspector. 'S C-�� WMb CcPYMapscMr'ss FlM C�n�ry CoPYfSib Notla .�,,.�-� ;�� . .. . . �� FiR.. ",��'y', � � � , . . . �F�, I a` �'i �`, ,�,.. " . . �,�;- „�: �; ,y. . �. ��� �F!... .�. 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