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Home My WebLink About2015-00048 - sewer disconnection CITY OF ORONO * 2 0 1 S - 0 0 0 4 8 2750 KELLEY PARKWAY DATE ISSUED: 01/15/2015 ORONO,MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 4680 NORTH SHORE DR PIN : 07-117-23-32-0050 LEGAL DESC : TONKAVIEW GARDENS : LOT 000 BLOCK 000 PERMIT TYPE SEWER PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE DISCONNECTION NOTE: SEWER DISCONNECT ONLY APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER&WATER 5.00 PROFESSIONAL GROUNDS MAINTENANCE MAIL-IN FEE 2.00 1515 CONSTANCE BLVD NE HAM LAKE,MN 55304 TOTAL 57.00 (763)434-3494 Payment(s) Minnesota State License#: SW-057136 CHECK 52423 57.00 OWNER Tonka Lake Properties LLC 3535 CTY RD 44 MINNETRISTA, MN 55364- 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. n Applicant Pe itee 'gnature Date Issued By Signature Date FOR CITY USE ONLY �oNo City of Orono Date Received: Permit# P.O.Box 66 2750 Kelley Parkway ❑In-House SAC Determination Form Completed Crystal Bay,MN 55323 �" FS H o E��. (952)249-4600/Fax(952)249-4616 Approved By(If Required): �� .! CITY OF ORONO—SEWER&WATER/GENERAL PERMIT r (*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) c�0�� GENERAL INFORMATION � 1. You may apply for utility permits by mail or in person at the City offices. C/T5, 'fi�014 2. Mailed in applications are subject to the postage and handling fee shown below. Permit cards will OF p be sent by return mail within 2 business days. 4�/1/d 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)2494600,24+hour notice required. TYPE OF PERMIT Check All That Apply) Residential(May Require Approval) ❑Commercial(Approval Required) ❑New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ,r Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address: (16 go N• S ko Owner: ky'Le Mailing Address: 3 City: V N r'e�-P CAA /� ^1 / Zip: S_<_3 1S c� Home Phone: Alternate Phone: `7 6 3 2ft — C7 C6 Contractor Information: (�� 5 ``Con�tralctor: �G'v` Contact Person: v 4 �,AC Address: 1 I '�__CotJ S6VecA- State License#: 11 _ I t3lo•1Pt Zip City: C �`" I�flk e :51;30y Expiration Date: Phone: 7 6 - t(314` 3 1-1 9 q Alternate Phone: 6 A DETERMINING PERMIT FEES ❑SAC Charge(2015 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 sew con tion permit will not be issued) ' GJ !Sewer Connection/ 'sconnec Repair($50.00/Per Stub) $ �d Pipe size inch ;mate 'al 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 Availability Exi lavation: 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) $ 2.2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ J" / 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 Ao the City of Prono for issuance of a Utility Permit,agrees to do all work in strict accordant ith the or ' ces the City and the regulations of the State of Minnesota,and certifie t all statemen ade this application are,true and correct. Applicant: Date: / �� - JCITY OF ORI,v..T CALLED IN DATE TIME INSPECTIO"OTJaF �ySCHEDULED PERMIT N( 20 f S L c)c>ItX COMPLETED ADDRESS OWNER TELEPHONE NO. LO(2 3103-s'lr7' CONTRACTORF� DESCRIPTION ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORE/WETLANDS h ❑ 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 v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL 2 OWNERICONTRACTOR O EET YOU:_YES_NO COMMENTS: Ci Cq):'De 0j Cr. r O O W cc Q 2 W Z W cc J LQ' ORK SATISFACTORY:PROCEED El PROJECT COMPLETE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY C) BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ PHOTO TAKEN INSPECTOR WILL RETURN El CITATION ISSUED ❑STOP ORDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site: f�Inspector. � White Copyllnspector's File Canary Copy/Site Notice