The URL can be used to link to this page

Home My WebLink About2016-00707 - sewer disconnect ,.�., CITY OF ORONO * 2 0 1 6 - 0 0 7 0 7 * � 2750 KELLEY PARKWAY DATE ISSUED: 06/24/2016 ORONO,MN 55356- (952)249-4600 FAX: (952) 249-4616 ADDRESS : 3188 NORTH SHORE DR PIN : 09-117-23-32-0011 LEGAL DESC : CRYSTAL BAY PARK : LOT 000 BLOCK 004 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION NOTE: 04/07/16-PER ROGER PEITSO,BUILDING OFFICIAL. SAC GRANDFATHERED IN H/U PROJECT#1785 04/10/68 AND HOME BUILT IN 1952. APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER&WATER 1.00 TMS COMPANIES TOTAL 51.00 5990 MEADOWLARK LN Payment(s) PRIOR LAKE,MN 55372- CHECK 4483 51.00 (612)414-5700 OWNER RUCINSKI,MICHEAL&HOLLY 3188 NORTH SHORE DR WAYZATA,MN 55391- 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 dces not grant permission for additional or related work which requires separate 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 suthorized 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 ass g all required inspections are requested in conformance ith th te Building Code.This permit may be revoked ' e for cause. T ,�],�-, 1'lA'� �Z`7 ��..�.��G C� /Z� / �f° Ap icant Permi e Signature Date Issued By Signatur Date � �, � . __----- 1�OR��i�ST UI�fiLY $-�NO�� City of Orono DaceReceived: ' Pe,a�itl� ZOl6- O T7Q� ; P.O.Box 66 `J 2750 Kelley Parkway ❑In-Iionse SAC Detertnination Form Completed � ,�-% Crystal Bay,MN 55323 s y`'�'��sHo¢``G` (952)249-4600/Fax(952)249-4616 Approved By(Tt'Itequired): CITY OF ORONO-SEWER& WATER/GENERAL PERMIT (*Note:Some permits may require approval by the Building Official and/or Public Works Departrnent►) (ALL PERMITS- Mav be subiect to further review and mav not be issaed when the aoolication is receivedl GEI�iERAL INFORMATIOl� _ 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 pernut 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 sdib 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 dces 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 PER�vIIT Clreck All That A i ❑Residential(May Require Approval) ❑Commercial(Approval Required) ❑New Connecrion ❑Additional Connection ❑Re-Connection ❑Repairs „ja'Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Si�te/Ov�er Ir�o�ation: Site Address: � 1 g� /v�� 'j�� IJ r 1.U2� Owner: �l�G��l �L��s� � Mailing Address: 1 �31 S�ou��,� zT' c�ri: � 1 y��vYl� ZIP: ss`��7 Home Phone: �I�Z��o�- �� Alternate Phone: Contractar Information: Contractor: � dKl� Contact Person: � , �r.•�� Address: �7/� f��CG� /��d� State License#: Z�U S�� Z� City: �r�o�G��P Zip: 1`�3�Expiration Date: Phone: �J 7�y�7��f�l Alternate Phone: .► '. I�T'E�1��PE�T'FEES ❑ SAC Charge(2015 Rate=$2,485.00) $ (SAC Chazge must accompany all sewer permit applications unless prepaid) rono City Staff can determine if applicable) (If not prepaid,a sewer ection permit will not be issued) Sewer Connection isconn /Repair($50.00/Per Stuli) $ Pipe size ii� • aterial 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 Availabilitv Eanlanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Department. , RecLuired Before Water Connecrion Permit is Issued: 1. Issue Water Meter&Horn Permit 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Connecrion 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 1-3 Above) $ ADDITIONAL INFORMATION-WATER METERS ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a senarate nermit. ■ 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 wit the r 'nances of the City and the regulations of the State of Minnesota, and certifie that all '� eme made this application are,true and correct. Applicant: Date �� DATE TIME CITY OF ORONO CALLED IN INSPECTION NOTICE SCHEDULED � % �-> - PERMIT NO. t1/f.�ti b 7��COMPLETED ADDRESS �1 SX� N _ -��I�!j/(� �� OWNER TEIEPHONE NO. �� y�� CONTRACTOR -��-� � DESCRIPTION �� -z�'G'�� ly ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TFiEE REMOVAL Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS � ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATIONlREMOVAL J ❑ DEMO-SITE ❑ SE T INSTALL Z OWNERICONTRACTOR TO MEET YOU: ES_NO c�., COMMENTS: � ' / _ 4 7 fr �i�� !"t�� .t'L�i� � � � � /� - ` 0 ,7!"'E:YYj i'Y�/� � /Ul�2jE,� �'—E�•^t/��r�% �`�%"7?�l��l[Y � �`~' �i1�� '�//�� % �s�'�Ci-�. . -- - - 0 � � W � Q � 2 W � W � j W�WORKSATiSFACTORY:PROCEED �OJECTCOMPLEfE WO�RRECT WORK 3 PROCEED O ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECONERING PERMANENT ❑CORRECTUNSAFECONOITIONWITHIN HOURS. ❑pHOTOTAKEN INSPECTOR WFLL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTION REWIRED.CALL TO ARRANGE ACCESS. Cail for the next inspection 2a hours in advance. (g52) 249-48�� OwnerlContractor on site: �, Inspector: �-=k� �_ White Copylinspector's File Cenary CopylSfte Notice �� s��-�- ,/ �� DATE TIME CITY OF ORONO CALLED IN INSPECTION NOTICE SCHEDULED oZ !�o PERMIT NO. �D !(r �p�C�7 COMPLETED �� ADDRESS 3 f �� / � Or 7�y., �.`'Lc�� plZ j, OWNER TELEPHONE NO. �� J70v CONTRACTOR �f� 5 � DESCRIPTION �� t-�"1/}�� ❑ FOOTWG ❑ DEMO-FINAL ❑ SEPTIC FIN�� 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 Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP 4J ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL _ v ❑ DEMO-SITE ❑ SEPTIC INSTALL 2 OWNERICONTAACTOR TO MEET YOU:_YES_NO � COMMENTS: � W � 2 J O � � O � W � Q � 2 W � W � � J d W ❑WORKSATISFACTORY:PROCEED ❑ PROJECT COMPLETE � ❑CORRECT WORK 8 PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDIT�ON WITHIN HOURS. ❑ pHOTO TAKEN INSPECTOR WILL REfURN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED O INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Cail for the next inspection 24 hours in advance. (952� 249-4600 OwnerlContractor on site: Inspector. White Copyllnspector's File Canary CopylSite Notice