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Home My WebLink About2016-00808 - sewer disconnection r , - CITY OF ORONO * z 0 1 6 - 0 0 8 0 8 * 2750 KELLEY PARKWAY DATE ISSUED: 07/14/2016 ORONO,MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 3470 NORTH SHORE DR PIN : 08-117-23-43-0012 LEGAL DESC : BALDUR PARK : LOT 001 BLOCK 003 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION NOTE: SEWER DISCONNECT APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER&WATER 1.00 BOLLIG&SONS,INC. TOTAL 51.00 11401 COLJNTY ROAD 3 Payment(s) HOPKINS,MN CREDIT CARD 6881 51.00 (952)938-4433 OWNER BROUELLETTE,HAROLD 3470 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 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 within 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 assuring all required inspections are requested in conformance with the State Building Code.This permit may be revo at a time for due cause. `.' /� 7 � � Applicant Permitee Signature Date Issued By Si ature Date ��, � �a��SE ONLY /!�0/�/� City of Orono [r�ce xeceiv �; Perm�t# P.O.Box 66 ` � 2750 Kelley Pazkway ❑In-House SAC Detummahon Form Co�leted � Crystal Bay,MN 55323 '.`c'� (952)249-4G00/Fa�c(952)249-4616 Approved By(If Required): 'ti�,��„v-�� CITY OF ORONO-SEWER&WATER/GENERAL PERMIT ('�Note:Some permits may require approval by the Building Official and/or Public Works DepaRment•) (Ai,L PERMI7'S- Mav be subiect to further rev(ew and mav nat 6e issued when tde aoolicatlon 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 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 avaitable on the job site. 5. Utility coanection pernuts may be issued to licensed contractors only. 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locarions. DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without eapress approval of the Pubtic Works Department. Issuance of a pemut 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 reqaired. TYPE OF PERMIT Check All T'hat A 1 �Residential(May Require Approval) ❑Commercial(Approval Required) ❑New Connection ❑Additional Connection ❑Re-Connecrion ❑Repairs �isconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address: �� J � � r��1� 'J'� Owner: �� v�� Mailing Address: �L�� / V ��h� "'� c�ri: C�rbt�� zip: ��53� I Home Phone: Altemate Phone: 1�" Contractor Information: Contractor: ��'�� _�� Contact Person: �� Ada�ss: l I�l�l � l�t� \J State License#: City: 1�� Zip:��_I� Expiration Date: cl -� G t Phone: J�1-�J�— I�� Altemate Phone: . , . . DETERMINING PERMIT FEES � ❑SAC Charge(2016 Rate=S2,485.00) S (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($50.011/Per Stub) $ Pipe size inches;material Schd 40 air tested; cast iron ❑Water Coanection/Disconnect/Repair(550.00/Per Stub) $ Pipe size inches;material Schd 40 air tested; copper ❑Water Availability For Fature Hook-Up to Water($50.00) $ Water Availabilitv Ezulanallon: Contractor installed line to inside of house for fuWre hook-up. This line will be inspected by the Public Works Department. Required 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 Pernut 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 se arate.permit. • WATER METERS must be set and sesled by Orono Water Department (952) 249-4600, upon completion of ineter installation. T'he 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 c 'fie that all s tements made on ' application are,true and conect. Applicant: Date: �' � � "� � �,� ��c � / DATE TIME / CITY OF ORONO CALLED IN �� INSPECTION TICE v SCHEDULED ��___s5" � PERMIT NO. ' ��J COMPLETED ADDRESS �� L� �-�� - OWNER TELEPHONE NO. �la S��p�X CONTRACTOR ��f�, r -�� : DESCRIPTION �`S�'��'� ly ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING Q ❑ 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 W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL _ v ❑ DEMO-SITE ❑ PTIC INSTALL 2 OWNERlCONTRACTOR TO MEET YOU:�YES_NO c�., COMMENTS: •'—'�� W 0. � � C64�� r c� C�r� 0 � � 0 � W � � Q -� � 2 � W � j ��RK SATISFACTORY:PROCEED /�PROJECT COMPLETE � �❑CORRECT WORK 8�PROCEED � ❑ ISSUE CERT�FICATE OF OCCUPANCY 0 ❑CARRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECT UNSAFE CONDiTION WITHIN HOURS. p pHOTO TAKEN INSPECTOR WFLL REfURN O CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALLTO ARRANGE ACCESS. Cail for the next inspection 2a hours in adv,�nce. (g52 j 249-4600 OwnerlCorttractor on site: � �% d i Inspector. �� n�1"/ White Copyllnspector's Ffle Canary CopylSite Notice