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HomeMy WebLinkAbout2013-00340 - sewer connect CITY OF ORONO * 2013 - 00340 * 2750 KELLEY PARKWAY DATE ISSUED: 05/13/2013 ORONO, MN 55356- (952) 249-4600 FAX: (952)249-4616 ADDRESS 4731 NORTH SHORE DR PIN 07-117-23-32-0067 LEGAL DESC BERGQUIST&WICKLUNDS PARK : LOT MB BLOCK 5 PERMIT TYPE SEWER PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE CONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 GROTH SEWER&WATER STATE SURCHARGE SEWER&WATER 5.00 775 TOWER DRIVE HAMEL,MN 55340- TOTAL 55.00 (763)478-6712 OWNER BWB Holdings LLC 3800 AMERICAN BLVD W#100 BLOOMINGTON,MN 55431- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved pians 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 an e foEduuse. —Applicalit PefmifeeSignature Date Issued By Sigo tu re Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO FOR CrrX USEONLY ; /�g01�Td City of Orono .Date Received: PCrmitW ( P.O.Box 66 2750 Kelley Parkway ©ln'-House SAC Determination Form Completed y Crystal Bay,MN 55323 (952)2494600 Approved By(if Required): garsxoR� 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 subiect to further review and may not be issued when the aoolication 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 ❑Repairs ❑Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Omer Information: Site Address: L(73 N 6r` k sht1c Owner:CO �S'b y 6&5 fyYv 4JV7v_�ailing Address: 2 !P todt�:;c sr— City: Zip: 56331 Home Phone: Alternate Phone: 0 a 0-75 Cl ;)-L40 Contractor Information: Contractor: ✓'D �I w Contact Person: Address: 775 76 ul`1 �� State License#: Pfy\ © �p 0 (O City: 4AAMt Zip: �ikpiration Date: Phone: �7�3 - 4?k-67 12 - �Alternate Phone: ^l.--2S f DET RMW,IN P S 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) � SewerConnec ion/Disconnect/Repair($50.00/Per Stub) $ o O--O Pipe size inches;materialip0C., 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 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) $ ADDITIONALINFORMATION-WATER METERS ■ W TER METERS must be picked up and paid for at Orono City Hall,these are on a separate permit. ■ W TER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon co pletion of meter installation. i The undersigned hereby applies to the City of Orono for issuance of a Utility Permit,agrees to do allw rk in strict accordance with the ordinances of the City and the regulations of the State of Minn sota,and certifies that all statements made on this application are,true and correct. Appli anItl(3a� Date: 5//V/3 DATE TIME CITY OF ORONO CALLED IN �-�— INSPECTION TI E O 3 /O SCHEDULED PERMIT NO. ` (J COMPLETED ADDRESS �_)Oak OWNER TELEPHONE NO. CONTRACTOR L A- CN``I 6-no 3Z DESCRIPTION �-�J(2r (cA- o t t'9 ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHOREIWETLANDS 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 v ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL v ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL Z OWNER/CONTRACTOR TO MEET YOU:_YES_NO y COMMENTS. W C J O O W W Cr Q `tS'- W QC 4j1N4MKSATISFACTORY:PROCEED ❑ PFQJECT COMPLETE uj ❑CORRECT WORK&PROCEED p�1` `7❑4�UE CERTIFICATE OF OCCUPANCY ❑CORRECT WORK,CALL FOR REINSPECTION VJ^ �{ TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN H RS. ❑PHOTO TAKEN INSPECTOR WILL RETURN ❑STOP ORDER POSTED.CALL INSPECTOR ❑CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE AC ESS. Call for the next inspection 24 hours In advance. (952) 249-4600 Owner/Contractor on sit- Inspector. 14?z�a 6 5 White Copylinspector's File Canary Copy/Slte Notice