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Home My WebLink About2011-00415 - sewer re-connect CITY OF ORONO PERMIT NO.: 2011-00415 2750 KELLEY PARKWAY ' ORONO, MN 55356- �ATE IssuED: 06/03/2011 � 952 249-4600 FAX: 952 249-4616 ADDRESS : 3095 NORTH SHORE DR PIN : 09-117-23-32-0014 LEGAL DESC : REG. LAND SURVEY NO. 0670 : LOT 000 BLOCK 000 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE t�iC�CONNECTION NOTE: RE-CONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 BOLLIG& SONS, INC. STATE SURCHARGE SEWER& WATER 5.00 11401 COLJNTY ROAD 3 HOPKINS,MN TOTAI, 55.00 (612)938-4433 OWNER SIME,MICHAEL& PAMELA 1592 MEDINA 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 Sta[e 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 whether or no[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 Sta uilding Code.This permit may be revoked at any time for c ��' � �L"� � S� / �� Applicant Permitee Signature Date / / Issued By � ature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. �_� FOR CI'CY USE ONLY f a CltyOt��1'On0 Date�Received: � Permit# /�¢ �Q\ P.O.Box 66 � 2750 Kelley Park��a}' ❑�In-1 fouse SAC�Determination Form Completed �� 'n.;� Crystal Bay,MN 553'_3 � � ��,t��;j��u`� (952)249-4600 Approved By(If Required): �`ais'so$ CITY OF ORONO—SEWER& WATER/GENERAL PERMIT � (�'Note:Somc permits may require approval by the Building Official and/or Public Works Department*) (ALL PER�1ITS- Dia��be subiect to 4irther review and mav not be issued when the aoplication is received) GENERAL 1NFORMATION 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 permits may be issued to licensed contractors only. 6. Contact the Public Worl<s 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 warl<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 Approva]) ❑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: � �� S NC�r �� hd r{', ��'. Owner: �% /✓�� : Mailing Address: City: Zip: Home Phone: Alternate Phone: Contractor Information: � Contractar: �O l �� y � �Urt S Contact Person: �'�� Address: ��1 �'c> �� State License#: ./��/� � �� 1��r City: �l� S Zip:�,_7�j Expiration Date: o?" �`� �� . / l l��o Phone: �s�" �5� �/�3_� Alternate Phone: �/�� ,�,�.;��:;� � �� ;��"x'E�IINING�',.�� ,�� ,, ��, ❑ SAC Charge(20l l 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�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($50.00) $ Water AvailabititV Explanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Department. Reauired Before Water Connection Permit is Issued: 1. Issue Water Meter&Horn 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 Mai]-In Applications) $ 2.00 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 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 accardance 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. i' Applicant: � Date: `' ��< � /�/��E� � TIME � ��ITY OF ORONO LED IN � � INSPECTION NOr�T�I�CE ,/ rI �SCHEDULED � � PERMIT NO. r�� l�— Cl J`t I� COMPLETED ADDRESS � � 1.C C� OWNER TELEPHONE N ja -��'t-� � CONTRACTOR � ��' �� DESCRIPTION c�--'�-�� t f" �G � � �� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICALRI ❑ LAKESHORENVETLANDS � ❑ 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 � COMMENTS: � a �. o r� � � T� � � �� 0� '' L�-�-r}✓s.e * � i c:� N^-� c� ��c>. ��; 0 � � _ �Gv► 'T�v(� l�ca.>' �S i u �-�,'� �. �'�.�A y Q - z �'� � l .� fi'v ��A�-e �9 5- �� -- W • � W � � � WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W ❑CORRECT WORK 8 PROCEED C ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑ INSPECTIONREQUIRED.CALLTOARRANGEACCESS. Cail forthe next inspection 2a hours in advance. (952� 249-46�� OwnerlContractor on site: Inspector. .�`7 � White Copyllnspector's File Canary CopylSite Notice