HomeMy WebLinkAbout2018-00176 - sewer connection t CITY OF ORONO 1',
*
2750 KELLEY PARKWAY * 21 8 - 0 0 1 6
DATE ISSUED: 02/20/22 018
ORONO,MN 55356-
(952) 249-4600 FAX: (952)249-4616
ADDRESS : 2320 OLIVER HILL
PIN : 34-118-23-33-0074
LEGAL DESC : OLIVER HILL
: LOT 4 BLOCK 1
PERMIT TYPE : SEWER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : CONNECTION
NOTE: SEWER CONNECTION
APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00
STATE SURCHARGE SEWER&WATER 1.00
GILES BROTHERS EXCAVATING INC
4114 JUDY CT TOTAL 51.00
NEW MARKET,MN 55054
Payment(s)
(612)366-4995 CREDIT CARD 5684 51.00
Minnesota State License#:GENR-PB645357
OWNER
HOVDE,OLE&CARLIE
2320 OLIVER HILL
LONG LAKE,MN 55356-
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 onformance with the State Building Code.This permit may be
revoked at y time for due cause.
Ap • tmitea e S iOPIP
Date Issued By ignatt) Date
I" g ,,
O 0 City of Orono Date Roceiv ��l
P.O.Box 66
2750 Kelley Parkway Q In-House SAC Determination Form Completed
� Crystal Bay,MN 55323
l,�AssHo.4
(952)249-4600/Fax(952)249-4616 Approved By(If Required):
CITY OF ORONO-SEWER&WATER/GENERAL PERMIT
(*Note:Some permits may require approval by the Building Official and/or Public Works Department s)
(ALL PERMITS- May be alibied to further review and may mainlined when the sooie tlonis rewind)
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+hoar notice required.
TYPE OF PERMIT .
(Check All That Apply)
rtl Residential(May Require Approval) 0 Commercial(Approval Required)
New Connection ❑Additional Connection ❑Re-Connection ❑Repairs 0 Disconnect
0 Water Availability Connection For Future Hook-Up to Water
Job Site/Owner Information:
Site Address: 62 5 °? 6 0 // v r////l
Owner: / 5 ji/ 4 Mailing Address: ..02.2; ti 0 &cid i?l o1
City: La. lie v 7/ Zip: y5/
Home Phone: ?SO?- 5/6 9- yo te to
Alternate Phone:
Contractor information:
Contractor: 6//es groc, (1:1(C . Contact Person: A 0 r 'H ‘•,/.0-j
Address: `7//47 vc" 4/ State License#: re LeL53SI
City: / )4`'a rk Zip: 6-&-o 5
c/,u cExpiration Date: .1?//5/17
Phone: Alternate Phone: CP /02- 3 0 b-"/77
a
DETERMINING PERMIT FEES
0 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 sewer connection permit will not be issued)
❑Sewer Connesiion/Disconnect/Repair($50.00/Per Stub) $ '
Pipe size 4 inches;material PvL 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 Ezulanation:
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: $— S O`
0-6
2. STATE SURCHARGE $ 1.00
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ -100
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ 5 I e
cro
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 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.
Ce-/-AM Date: —Q — l P
Applicant: � �i���
I s DATE TIME. V
CITY OF ORONO CALLED IN VV
INSPECTION NOTICE SCHEDULED 3-t-17 )O
PERMIT NO.9-01z'-DO17/a COMPLETED I'
ADDRESS c�3 -C) O II /ex �, 1 (
OWNER ��ss TELEPHONE7s4;./.2.--36'(o-V229s
CONTRACTOR (9-i 116CXR_Ati0.-41�- /ri/L-
DESCRIPTION �� e,r
Lu ❑ FOOTING 0 DEMO-FINAL 0 SEPTIC FINAL
Q ❑ POURED WALL 0 PLUMBING RI 0 EXCAV/GRADING/FILLING
0 FOUNDATION DRAIN TILE 0 PLUMBING FINAL Q TREE REMOVAL
Z• ❑ LATHE 0 MECHANICAL RI 0 SITE INSPECTION
Q 0 FRAMING 0 MECHANICAL FINAL 0 RATED WALLS
• ❑ INSULATION 0 WOOD BURNER/FIREPLACE 0 COMPLAINT
Q ❑ FINAL ElWATER HOOK-UP 0 FOLLOW-UP
W ❑ AS BUILT-SURVEY 0 SEWER HOOK-UP 0 FOUNDATION/REMOVAL-
❑ DEMO-SITE 0 SEPTIC INSTALL
Q OWNER/CONTRACTOR TO MEET YOU:_YES NO
COMMENTS: I` fv L 5‘-h 96 51,-31/411^9(
5-e�I.J/ C--.e-"Ii -r✓'4cecWI"W /
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W
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W coR -
mK SATISFACTORY:PROCEED /❑ PROJECT COMPLETE
W
0 CORRECT WORK&PROCEED 0 ISSUE CERTItICATE OF OCCUPANCY
CI 0 CORRECT WORK,CALL FOR REINSPECTION _„TEMPORARY
✓ BEFORE COVERING '. PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. 0 TAKEN
INSPECTOR WILL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR 0ITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 urs in advance. (952) 249-4600
Owner/Contractor on site: -i re
Inspector. 'AD
White Copyllnspector's File Canary CopylSite Notice
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