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Home My WebLink About2019-00212 - sewer disconnect - CITY OF ORONO PERMIT NO.: 2010-00212 2750 KELLEY PARKWAY ' ORONO, MN 55356- DATE ISSUED: 04/12/2010 952 249-4600 FAX: 952 249-4616 ADDRESS : 3530 NORTH SHORE DR PIN : 08-117-23-43-0010 LEGAL DESC : BALDUR PARK : LOT 004 BLOCK 002 PERMIT TYPE : SEVJER PROPERTY TYPE : RESIDENTIAL COI�TSTRUCTION TYPE : DISCONNECTION NOTE: SAC GRANDFATHERGD IN-CR�D1T GNL;N APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 DAVE'S EXCAVAT[NG INC. STATE SURCHARGE SEWER& WATER 0.50 16110 HALSEY AVENUE TOTAL 50.50 CARVER,MN 55315- (952)448-3642 Minnesota State License#: 075981 RP OWNER ACKERMANN, ALBERT 3530 NORTH SHORE DR WAYZATA, MN 55391 AGREEMENT AND SWORN STATEMENT Thc work for which this permit is issued shall be performed according to the approved plans and specifications,applicable City approvals,and the State I3uilding 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 ofwork 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 I 80 days at any time after work has commenced. The applicant is res sible for assuring all required inspections are requested i co r ance with t e State Building Code.This permit may be revoke y ti e for du se � � � a l� � � Applicant Permitee Si nature Date Issued By Si ure D SEPARATE PERMITS REQUIRED FOR WORK OTHER T AN DESCRIBED ABOV , 'i .f�. . . .-..' - '_.,Iir�Gw_i�.� 4t �. � 7�Y'nK1t� '��'! �:i:S:t� ti,t' ` + �aCfi'!3ai� ��; .+.:�t+c�:;.� �?OY' :r:. s'��1�, �}7Yrz.'S tk�:c'.':3L:It:3 h'ti!'t"IAl:S c n 2(?lt�-L�f;i'.1� 35�E1 r�u�`1h �it� .n:.ty�� ;e �i' i��:.t-�,'.'��.� ', �i�i:.7�i11 Cai f'':�°y t i i r�t il$T' i�rr�it� ,,, � � �i?j�l"1�'��lC ,��: �ti:,Y.'��i .�hL• "'�l , ;'2 �'s' ! i w�j"i;�1i� Uua 'r,a novts�•j4a'r.e ___ _--•w.__ 4�� .+ ,� Trf�CS: .J�,.,J'�t , . ...—_..,....._.-_'__.__ i 'v�'kL�,'��f rr' r.��. £h8::k � FA�a � �� " '`�`' :'a�r,r: r 1 �� t�.J.�V��:1 �H�6d�b iYi� �1 � ' T��tal �4;:;+ii�:; .:`�':�- � -----_.......,_. �;!�.3r�� f�n,?NreU: •�F' i ____......__-_�.._ i , i�k�iell.lJ �.i'.>'�SP!� i � FOR CITY USE ONLY ` Clty of 01'Ono Date Received: Permit# � 4�� P.O.E3ox 66 '� �'� 2750 Kelley Parkway ❑In-House SAC Determination Form Completed �� )t�� Crystal Bay,MN 55323 � � � u�� (952)249-4600 Approved Dy([f Required): �i,��o�t�,.' CITY OF ORONO-SEWER& WATER/GENERAL PERMIT (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) (ALL PERMITS- Mav be subicct to further review and mav not be issued when the anplication is received) 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 wil] 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 Works 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 wark 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: �S jU /G-/ ��D/�� ,��/�. Owner: ��/��/� Mailing Address: City: i�'/_>A/�J Zip: Home Phone: Alternate Phone: Contractor Information: . Contractor: S �C��, Contact Person: � � � ��-�� Address: �Co� G � . 5�� State License#: C� �S�j�,I — �1� City: Zip:S�>/SExpiration Date: Phone: �Sa '`��{c�-3(��{Z- Alternate Phone: (�(2- --�0�--g"�p�} � DETERMINING PERMIT FEES ❑SAC Charge(2010 Rate=$2,100.00) $ (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 Connectio /Discon�t/ epair($50.00/Per Stub) $ Pipe size in , erial 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 Explanation: Contractor installed]ine 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 Permit 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Connection Permit: 1. Collect Permit Fee&Issue Water Connectron Permit l. SUBTOTAL of Permit Requested: $ 2. STATE SURCHARGE $ .50 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(AddLines 1-3 Above) $ ADDITIONAL 1NFORMATION—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 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 cert' s�that all statements made on this application are,true and correct. � � ., ' ` �> Applica .` � � � ' Date: ��z � �� Reset Form � � ✓ �4� DATE TIME CITY OF ORONO CALLED IN i� I � INSPECTION NOTICE SCHEDULED � i � PERMIT NO. '_�L\ f C r �- � �'��EOMPLETED ADDRESS �� ; . _� �"1� 1''C .��►�- OWNER TELEPHONE NO. ��J�' y 't') "-��1{� CONTRACTOR -� ._'�1�--�_`��-- �' �-� � , � DESCRIPTION J �- �'`'�- r� � � �^�� _�I`� ��I'l� ri�-� � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORENVETLANDS � ❑ FRAMING ❑ MECHANICAL FINAL Q ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � ❑ FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT � ❑ 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 l'!.— \ � COMMENTS:�� CL��-E= - LL° l � � �;��'_,ss:�L,�, W a o t,J� �+ � t �.� e � ��e� c �-� � � o �� W � '� ��G� (� �Q��L� Q S �'C�✓��-t'^ � z W � W � J � �VORKSATISFACTORY:PROCEED ❑ PROJECT COMPLETE W ❑CORRECT WORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑ CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CORRECTUNSAFECONDITION WITHIN HOURS. � pHOTOTAKEN INSPECTOR WlLL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTfON REQUIRED.CALLTO ARRANGE ACCESS. Cail for the next inspection 24 hours in advance. (g52) 249-460� OwnerlContractor on site: ' Inspector. o �� White Copyllnspector's File Canary Copy/Site Notice