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Home My WebLink About2011-00084 - sewer disconnect � ,� '" CITY OF ORONO PERMIT NO.: 201�-000s4 2750 KELLEY PARKWAY ' ORONO, MN 55356- DATE ISSUED: 0?J07/2011 952 249-4600 FAX: 952 249-4616 ADDRESS : 4415 NORTH SHORE DR PIN : 07-117-23-43-0017 LEGAL DESC : SAGA HILL REVISED : LOT 000 BLOCK 018 " PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL � CONSTRUCTION TYPE : DISCONNECTION NOTE: SEWER DISCONNECT-PIPE SIZE-4" APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 WESTONKA SEWER&WATER STATE SURCHARGE SEWER&WATER 5.00 6501 CO.RD 15 TOTAL 55.00 MOUND,MN 55364 (952)472-4959 Minnesota State License#: 1804 OWNER TWOMEY,DAREA&CHRIS 150 2ND STREET NE MINNEAPOLIS,MN 5541� AGREEMENT AND SWORN STATEMENT T'he 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 goveming this type of work shall be compied with whether or not specified herein.This petmit 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 ys at any time after work has commenced. The applicant is respo o assuring all required inspections aze requesY�d in confo anc i the State Building Code.This permit may be re t y ' r cause. � � � ` � � / A plicant Permitee Signature Date Iss By Signature Date SEPARATE PERMITS REQUIRED FOR WORK O HER THAN DESCRIBED ABOVE. _. �` .FO$CLTY USE ONLX ' ,¢�� City of Orono Dat�Received: Peimit# P.O.Box 66 ��- � 2750 Kelley Parkway ❑In�House SAC Determination Form Completed ; � z ,v� Crystal Bay,MN 55323 , ��o� (952)249-4600 Approved Sy(If Required): a CITY OF ORONO—SEWER&WATER/GENERAL PERMIT (*Note:Some permits may require approval by the Building Official and/or Public Works Deparirnent'") (ALL PERMII'S- Mav be subiect to further review and mav not be issued when the aoalication is received) GENERAL INFORIVIATION = 1. You may apply for utility permits by mail or in person at the City offices. 2. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards will be sent by return mail within 2 business days. 3. Permits are not valid until you receive a permit card. 4. Work must not begin unless the permit card is available on the job site. 5. Urility connection permits may be issued to licensed contractors only. 6. Contact the Public Works Department(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without e$press approval of the Public Works Department. Issuance of a pernut 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. ° T'YPE OF PERIVIIT ' (Check All That APP1Y) ' ' ��Residential(May Require Approval) ❑Commercial(Approval Required) ❑New Connection ❑Additional Connecrion ❑Re-Connection ❑Repairs �Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Informa�ion: Site Address: �� `�� `°''� ��'��e Owner: Mailing Address: City: Zip: Home Phone: Alternate Phone: Contractor Information: ; Contractor: (�t�S�O��`- S�� Contact Person: ��iG,� C �� '1 Address: r C�, ��. �S State License#: j�`�� City: �� Zip: -J�.�y Expiration Date: 12��' �� Phone: ��-�(7�- �� Alternate Phone: � �� 7��- �7�� ,_ 'a =� � ,: : ,. . ��`'��T��,.�. . � ` '' �r��"�:. a, _._..�:^-� � ' _ .., .,° ,..�_. ,.._.. ` ,_' -: �.4 ❑SAC Charge(2011 Rate=$2,230.00) $ (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 iscon /Repair($50.00/Per Stub) $ Pipe size�inc es;�material � 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 Eznlanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Department. Reauired 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 $ .50 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ADDITiONAL INFOR11iIATION-WATER METERS ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a seuarate 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 City and the regulations of the State of Minnesota, and certifies that all statements made on this application are,true and correct. C Applicant: , Date: �7— �� ✓ ��F /� TIME CITY OF ORONO ALLED IN � INSPECTION.I�IQ�� p�CHEDULED /� �� PERMIT NO.ol(J �T COMPLETED • ADDRESS `�'` S / Y�Y\� .J ��- �J�" �� OWNER TELEPf 'H�NE NO.— CONTRACTOR __ �S W N S �: DESCRIPTION L�� S� �'c �I e-�� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLINC Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS � ❑ 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/CONTRACTOF TO MEET YOU:_YES_NO i, � COMMENTS:` 'SC��:i��c'7�-�'� � �-�-` %IE� �-�, 'l�'�-t,tJ W " •�, � _ � �� , 1��n y ��1, ��; �� - � ;L ,c��>.:�,, ;�.;, , 0 -�'.�.'�'iC(f t` ':c" ' � —a,.. �: �� . 5 •L �e,�1/�•-�� . � � p • � . , - _ `, lL - �. 1)iL/:'v�.-1 � �, . . �`F •�- W � Q � Z W � W � � d W� ❑WORK SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY � ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORECOVERING PERMANENT �CORRECT UNSAFE CONDITION WITHIN HOURS. G PHOTO TAKEN INSPECTOR WILL RETURN ❑ CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑ INSPECTION REQUIRED.CALI TO ARRANGE ACCESS. Call forthe next inspection 24 hours in advance. (952� 249-46�� OwnerlContractoronsite: �� ' ��-;�/�"r� ��-c.j��-f-� Inspector. '�'�� White Copy/lnspector's File Canary CopylSite Notice