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Home My WebLink About2015-00276 - sewer disconnect CITY OF ORONO * 2 0 1 5 - 0 0 2 7 6 * ' 2750 KELLEY PARKWAY DATE ISSUED: 03/09/2015 ORONO,MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 4009 NORTH SHORE DR PIN : 07-117-23-44-0004 LEGAL DESC : HIGHWOOD LAKE MTKA : LOT 000 BLOCK 000 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION NOTE: SEWER DISCONNECT APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER&WATER 5.00 KNAPP&SONS SEPTIC TOTAL 55.00 13574 110TH STREET Payment(s) MILACA,MN 56353- CHECK 5543 55.00 (763)477-8566 OWNER LUZICH,PETER&ELIZABETH 4009 NORTH SHORE DR MOLTND,MN 55364 AGREEMENT AND SWORI�T STATEMENT The work for which this permit is issued shall be perfortned according to the approved plans and specifications,applicable City approvals,and the State Building Code. This permit is for only the work described and dces not grant permission for additional or related work which requires sepazate permits. All provisions of laws and ordinances goveming 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 responsible for assuring all required inspections aze requested in conformance with the State Building Code.This pern►it may be revoke time for due cause. :: �,� � � � �-5 A licant Permitee ' Date Issue y Signature Date t ' FOR CITY USE ONLY Q�I�IO City of Orono nate Received: Permit# � P.O.Box 66 2750 Kelley Parkway ❑In-House SAC Detennination Form Completed i �f Crystal Bay,MN 55323 ''�� E� (952)249-4600/F�(952)249-4616 •4pp��BY(��9�)� kESH�,% CITY OF ORONO—SEWER&WATER/GENERAL PERNIIT (*Note:Some permits may requice approval by the Building Official and/or Public Works Department') (ALL PERMITS- Mav be subiect to farther review aed mav Aot be issoed w6en the sodication is receivedl 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 cazds 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 pernut cazd 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 ezpress 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: Site Address: ��D `�1 �� f-� ,,o �o� (�'. , l , Owner:�he.c'c .�c,hr� �� Mailing Address: �Q� �UiCt,� �� City: n zip: � 5�?/ Home Phone: I,� _ ��0 - ��U('� Alternate Phone: Contractor Information: %� cznlJ� �n5' cX'�,G `�L�i .�� Contractor: p� � Contact Person: --�U� Address: ��7"i� ��D � ��ef State License#: � �1��!3�� City: �i/cG� Zip��'3ExpirationDate: �02 3� ,� /.`� Phone: �G 3- y� �- �6� Alternate Phone: 4 ' t> �. f�a� ,t..a°�t €�',� f"�� ', i � � s.� '�✓ `�S , - , . , . , � .k �, i ..3a�t�f��x ❑SAC C6arge(2015 Rate=$2,485.00) $ (SAC Charge must accompany all sewer permit applications unless prepaid) , (Orono City Staff can determine if applicable) (If not prepaid,a sewer conn�tion permit wili not be issued) �wer Connecti isconnect/ epair(550.0(1/Per Stub) $ �� . ��() Pipe size m , al Schd 40 air tested; cast iron �Water Connec ' Disconnect/ air($50.00/Per Stnb) $ �� size � , enal Schd 40 air tested; copper �— ❑Water Availability For Future Hook-Up to Water($50.00) $ Water Availabilitv Eanlanation: 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&Horn Pernut 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Connection Permit: 1. CotIect Permit Fee&Issue Water Connection Permit 1. SUBTOTAL of Permit Requested: $ ��- �� 2. STAT'E SURCHARGE $ 5.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ –� 4. TOTAL PERMTT F'EE(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 permi� • 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 Pernut,agrees to do a11 work in strict accordance with the ordinances of the City and the regulations of the State of Minnesota,and ce ' es that all statements made n this application are,true and correct. Applicant: — Date: J��G1,� AT€ TIME� CITY OF ORONO cnLLED IN 3 �I �S �_ INSPECTIO IC� ��SCHEDULED L-�I PERMIT NO. �' �Z�`�sOMPLETED ADDRESS `-�� '�� S��Q� OWNER TELEPHONE NO. �� CONTRACTOR __�Ir�S �ZCo3 �� o:�wo � DESCRIPTION �.5� �-� �� W ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAI 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 ❑ PROGRESS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP _ ❑ AS BUILT-SURVEY FR��b� ❑ HARD COVER REMOVAL v ❑ DEMO-SITE ❑ SEPTIC INSTALL ❑ FOUNDATION/REMOVAL 2 OWNERlCONTIiACTOR TO M�ET YOU:_YES_NO — � COMMENTS: 7 ��'1 �f -��c�� 2�+/ �`' /L<��,o � �0.,�'.e d • � �7-�-r OC � W � Q � W � W � � J � '�WORKSATISFACTORY:PROCEED �OJECTCOMPLEfE W �O CORRECT WORK 3 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECTYVORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECTUNSAFECONDITIONWRHIN HOURS. ❑pHOTOTAKEN INSPECTOR WILL REfURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑INSPECTION RE(]UIRED.CALL TO ARRANGE ACCESS. Ca11 forthe next inspection 24 hours in advance. (g52) 249-460� OwnerlCorrtraator on site: �G4A�' �vrJ S Inspector: ��/ White CopyMnspector's Ffle Canary CopylSlte Notiee