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HomeMy WebLinkAbout2013-00380 - sewer disconnect ' ' �` CITY OF ORONO 2750 KELLEY PARKWAY * 2 0 1 3 — fd 0 3 8 0 * DATE ISSUED: OS/17/2013 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 4315 NORTH SHORE DR PIN : 07-117-23-43-0028 LEGAL DESC : SAGA HILL REVISED : LOT 000 BLOCK 018 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION NOTE: SEWER DISCONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 BOLLIG & SONS, INC. STATE SURCHARGE SEWER& WATER 5.00 11401 COUNTY ROAD 3 HOPKINS, MN TOTAL 55.00 (612)938-4433 OWNER WILLIAMS, MARTHA P 1911 BEACH LN 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 [he State Building Code. 'i�his permit is for only the work describcd and does not grant permission for additional or related work which requires separate permits. All provisions of laws and ordinances goveming[his 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 require � pections are requested in conformance wi[h the Stat i " ode.This permit may be revoked at r due ca / ' / / �/ � 7/ / Applicant Permi ee Signature Date Issued y Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. DETERMINING PERMIT FEES ❑ SAC Charge(2013 Rate=$2,435.00) $ (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/\ epair($50.00/Per Stub) $ �� GU Pipe size ir3el�es,-ina�erial Schd 40 air tested; cast iron ❑ Water Connecdon/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 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 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 Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE (Add Lines 1-3 Above) $ CJ J��GU ADDITIONAL INFORMATION—WATER METERS ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a s�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 accordance with the ordinances of the Ciry and the regulations of the State of Minnesota, and certifies t all state s e on this application are, true and correct. � / � ' Applican . Date: �J' �f 7-�-� FOR CITY USE ONLY R-U�V� City of Orono Date Received: Percnit# P.O.Box 66 ' 2750 Kelley Parkway ❑[n-House SAC Determination Form Completed Crystal Bay,MN 55323 �'.� �,��� (952)249-4600 Approved By(If Required): A!�li�)b CITY OF ORONO-SEWER& WATER/GENERAL PERMIT (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) (ALL PF.RMITS- Mav be subiect to further review and mav not be issued when the application is received) GENERAL INFORMATION L 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 Works Department(952-249-4600)for utility srizb 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 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: �.�J S ���:-`�� ;5 L,���--e. ��--��� Owner: ��K� u�„� P f C��e v���c�� Mailing Address: �J��� Ju✓���r�> �c y-' c�ty: F�y,�,��-Iti z�p: �S ���, Home Phone: 7� 7 �S 5 1- %�S�/ Alternate Phone: Contractor Information: Contractar: � ��; � %�,-,�� �, � Contact Person: ���� �X Address: �l�1U� C:;. �� � State License #: -3�jl City: �ap�Z��5 Zip:�S j`�3 Expiration Date: Phone: �S Z-`���` `���3-� Alternate Phone: ra�Z-3(�%�- �3 �f� �� � � �-� � �,`� =�.�1"' �� r�� � � r � .� ��i`�M� q � � �?�, ° �++Y� `�d� �� j V, wA �� , ,. ' � �. � • ,�, u.�..�,_ ' "`� _ . % .�Z; �� - . (�.� ° , w_`a "." j ct i�... < _�,.. . �y '�1 . 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' � .w .���� •/� � �•� � ��� ,� '� '• � , .*� � � � � 2 r � � 1 »'� �� �,. ,�`_� � 3.��.. �j� � �• .�i ..�J �� S��'� � � DATE TIME � CITY OF ORONO CALLED IN S` INSPEC+TION NOTI E SCHEDULED -� ._..l/: O O PERMIT IVO. ����3�� COMPLETED ADbRESS���3 ��"�&2� �� OWNER TELEPHONE NO. ��a ��� S� /�!✓ CONTRACTOR ����� ~ �� � DESCRIPTION � �s�'��`�� � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL ❑ 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 � OWNERlCONTRACTOR TO MEET YOU:_YES_NO � � � COMMENTS: y �45��'.r o� ,Sf�e�'i �S�aUic� a P�7�� d� �/J/10_�• j O / � �� �/G�L/��e O � W � Q � ,,9/ C� � -s ,.,,e W �C W � � � O W ❑WORK SATISFACTORY:PRO�EED ❑ PROJECT COMPLETE � ❑CORRECT WORK&PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY W O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT ❑CQRRECTUNSAFECONDITIONWITHIN FiOURS. p pHOTOTAKEN tNSPECTOR W{LL RERIRN ❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED ❑INSPECTtON REQUIRED.CALLTO ARRANGE ACCESS. Call for the next inspection 24 hours in advanc�. (952) 249-46�� OamerlContractor on site: 3°���o'�s ao1S Inspector. �a�D�ei'"�/,9�1��' White CopyAnspecto�'s File Canary CopylSite Notice