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Home My WebLink About2017-01109 - water/sewer disconnection CITY OF ORONO �� '11 * 20 1 7 - 0 1 1 09 * 2750 KELLEY PARKWAY DATE ISSUED: 09/22/2017 ORONO,MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2625 KELLY AVE PIN : 20-117-23-14-0026 LEGAL DESC : TOWNSITE OF LANGDON PARK : LOT 000 BLOCK 005 PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION NOTE: WATER AND SEWER DISCONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 WATER CONNECT/DISCONNECT/REPAIR 50.00 J S STEWART COMPANIES,INC. STATE SURCHARGE SEWER&WATER 1.00 11030 LAMONT AVE NE HANOVER,MN 55341 MAIL-IN FEE 2.00 () TOTAL 103.00 Minnesota State License#:sept-L703 Payment(s) CHECK 7934 103.00 OWNER ELLEN REDMOND REVOC TRUST 2625 KELLY AVE EXCELSIOR,MN 55331- 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 after 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 revoked at any time for due cause. gay /7 Applicant Permitee Signature Date Issued B ignature Date • RECEIVED SEP 112017 — FOR CITY USE ONLY 1)-15//6 -9.-0/1/,.., City of Orono CITY OF ORONODate Received: Permit# P.O.Box 66 2750 Kelley Parkway 0 In-House SAC Determination Form Completed �y Crystal Bay,MN 55323 /6,3 (/ tp (952)249-4600/Fax(952)249-461 J Approved By(If Required): \, IktsH ON°, V,v CITY OF ORONO—SEWER& WATER/GENERAL PERMIT (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) (ALL PERMITS- May be subject to further review and may not be issued when the application 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 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 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 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 Apply) Residential(May Require Approval) ❑Commercial(Approval Required) ❑ New Connection ❑Additional Connection ❑ Re-Connection ❑RepairsDisconnect EI Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address: 2(.0 Z S k 1 j Ye. 0 vo Vl 6 Owner: £1 1 etk te_e(iL n Mailing Address: Z10 Z5 16,11_J� Eve_ 1 City: OVYLO Zip: SS 3 31 Home Phone: Ce ( Z 3100 Z(o(o Alternate Phone: Contractor Information: Contractor: J&s4- wcVLt-eo lt,t... Contact Person: r C.l a, Address: I 030 La-W-0)1 frfVQ tEState License#: City: 4-{Q,it,aNtV Zip:$53 I Expiration Date: Phone: 71, 3 -9 Z J — 9 030 Alternate Phone: I Vl eJ SS4C44)a4 ,Cow\ .Er M 11 x ,. : =x,.'; TERMINING PERMIT FEES kr .T , 16 . ❑SAC Charge(2016 Rate=$2,485.00) $ (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/TDisconne.Repair($50.00/Per Stub) $ 50°—C2 Pipe size inches;material Schd 40 air tested; cast iron g]Water Connectio• I isconnect Repair($50.00/Per Stub) $ S000 Pipe size in - , . ertal Schd 40 air tested; copper ❑Water Availability For Future Hook-Up to Water($50.00) $ Water Availability 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: $ IDO 6 D 2. STATE SURCHARGE $ 1.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ )03. °O ADDITIONAL INFORMATION—WATER METERS • WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate permit. • WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon completion of meter installation. The undersigned hereby applies to the City of Orono for issuance of a Utility Permit, agrees to do all work in strict accordanc- , ith the ordinances of the City and the regulations of the State of Minnesota,an. �rtifies tha . s •'cements made on this application are,true and correct. Applicant: —/ 1 Date: 9- - / 7 / DATE TIME CITY OF ORONO CALLED IN INSPECTIONMICE TICE ///. SCHEDULED JO-g_-17 PERMIT NO. /7�``v ! COMPL ED ADDRESS c' 5 / ✓� OWNER �3 3� �� -TE�LEP ONE NO. CONTRACTO �d / 2/e S E SeG f iJ) i W 0 FOOTING 0 DEMO-FINAL 0 SEPTIC FINAL Q ❑ POURED WALL 0 PLUMBING RI 0 EXCAV/GRADING/FILLING 0 FOUNDATION WATERPROOF 0 PLUMBING FINAL 0 TREE REMOVAL • ❑ RADON SLAB 0 MECHANICAL RI 0 SITE INSPECTION Q 0 FRAMING 0 MECHANICAL FINAL 0 RATED WALLS F.. ❑ INSULATION 0 WOOD BURNER/FIREPLACE 0 COMPLAINT Q 0 FINAL 0 WATER HOOK-UP 0 FOLLOW-UP W 0 AS BUILT-SURVEY 0 SEWER HOOK-UP 0 FOUNDATION/REMOVAL ❑ DEMO-SITE 0 SEPTIC INSTALL 2S. OWNER/CONTRACTOR TO MEET YOU:_YES_NO El COMMENTS: 5.2er- UJ r4 S d SSC 017rIEe- 7-'el C`/a/)fto 1 )1/3�� N e f 4 Li7� 71s 'd Ct AJ ) OVI /C/n9 p -[ 4 VN1 iy/ 01ai-970 Ale t1c..[1 o N. IX 4 d I s n�r�r�&/e J cf t ,.v 0„ 71 C he‹, 41 lO DAd .- Dr'/�w�y /kit c.) /�AP jam'- ' u, Q -k-r-)c k S 7I0 CC e s S # S L A) y id i‹ 0.o n.>..LI"- /4/7pr' , w d 7s- i-t,4 y CC W WORK SATISFACTORY:PROCEED ❑PROJECT COMPLETE IXW ❑ RRECT WORK&PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY 0 0 CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. 0 PHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Cap for the next inspection 24 hours In advance. (952) 249-4600 OwnergContractor on site: 5 5 7 `)4''-7 Inspector e,CF Whit CopyAnspschx's File Canary Copy/SIN Notice