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HomeMy WebLinkAbout2017-00403 - sewer connect CITY OF ORONO [ [ II' I I I I 111 2750 KELLEY PARKWAY * 2017 - 0 0 4 0 DATE ISSUED: 04/24/2017 ORONO,MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2335 OLIVER HILL PIN : 34-118-23-33-0077 LEGAL DESC : OLIVER HILL : LOT 2 BLOCK 2 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 TOTAL 51.00 4114 JUDY CT NEW MARKET,MN 55054 Payment(s) (612)366-4995 CREDIT CARD 2625 51.00 Minnesota State License#:GENR-PB645357 OWNER D'ALESSANDRO,GREG&JENNIE 6368 HIDDEN LAKE CIR RICHLAND,MI 49083- 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 request in conformance with the State Building Code.This permit may be revoked t any time for due cause. i°6 iSSO 541g/ • Permite gnature Date Issued B gnature Date • �NL� ipp_L). 0 City of Orono nage Rax Pema[ oZ01 7_ USE P.O.Box 66 ��'/ 7 2750 Kelley Parkway 0 In-House SAC Determination Form Completed Crystal Bay,MN 55323 �kEs H o4 (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*) (ALL PERMITS- May be subiect to(nether review and may motile issued wles ffie anoiiratlon 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+honr notice required. TYPE OF PERMIT . (Check MI That Apply) . (Residential(May Require Approval) ❑Commercial(Approval Required) NEINew Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect 0 Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address: k g 3 C 1,✓p A/,/ Owner: /0%in j Add 17 e S Mailing Address: a a a 0 o La 01 1/vol A //� rlZip: L f�-e v� zggiv City: � 5-5-0 s—i Home Phone: 75 a - y l"9 o le/O Alternate Phone: Contractor Information: • Contractor: G1 i-Ds ra cherS 4>ce . Contact Person: ,fh v`v r, . Address: J 1/y 7v' -, el" State License#: ?8. l)y53 S 7 City: A/P`'�ma�'�� Zip: �3� Expiration Date: / 7.d //j 7 Phone: 6 is -?l,l0 -4/995 Alternate Phone: DE ERlasini :l FEES - i 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) 0 Sewer Connection/Disconnect/Repair($50.00/Per Stub) $ Pipe size`q` inches;material PVC- 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 $ 1.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ 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, certifies that all statements made on this application are,true and correct. Applicant «---' Date: . OFFICE STAFF FOR OFFICE USE ONLY PLACE SIGNED ORIGINIAL IN - � Building Permit PERMIT FOLDER Amount Due: $ '69) .16.0.161M'x»« CITY OF LONG LAKE I VI Da�te Paid: M I 450 Virginia Avenue, PO Box 606 CCO NGUPRO PROPERTY FILE OFFICIAL,ILDING Check# Long Lake, MN 55356 Cash Receipt# C I T Y 0 F Phone/ 952.473.6961 �� ��� LOC/ Bond(s) Required? 211QLONG LAKE Permit #B ('�. - t J [ ]Yes [ No D -J Date Posted: + X BuildingOfficial / Staff Signature � Date Issued l'i Zl L f i COMMENTS Special Approval [ ] Planning/Zoning— Planning Case No. [ ] Fire Department—Staff Initials [ ] Engineering—Staff Initials [ ] Public Works Department—Staff Initials . ** PERMIT HOLDER: TO SCHEDULE INSPECTIONS,PLEASE CALL METRO WEST INSPECTION SERVICES AT 763.479.1720** Site Information Site Address (INCLUDE SUITE#) sass— ©LI 1.r 4' +>Li (I - iOI 3O Property ID# clA i2 aiioN6C7 0&.3 7vDl le/n , 4 LCC C E Permit Request—INCOMPLETE APPLICATION WILL NOT BE ACCEPTED Owner Information Contractor Information Name Name g.61:?p-i4V I , )OLA kln{-{cLz, t\ ifl :S Address Address 222(110 01),E) 12,1—V--) City/State/Zip City/State/Zip TUU t Ll - , 13 cso 'f 4 PhonePhone qP ..a. ----.67/ License # Project PROJECT VALUATION $ /\-')/Ct Estimated Completion Date 01A Information COMPLETE Description of Work &O - COk I CJ770&L i/('!LItf'2i iiLOSS /2-69126 RP-- 0/2-0/U0 `?)2,0. 421-1/ if-ia_6,-Cc 4 g,06-) /4tie_. - SYS7-0-4 NOTE: If permit request is for any new construction,an addition,deck/fencing,or any alteration involving a structural modification,PLEASE SUBMIT(2)COPIES OF DETAILED PLANSalong with this completed application form. SAC Has a SAC determination been completed? [ ] Yes [ ] No [ N/A(Existing Residential Only) Determination If"No", refer to Service Availability Charge handout for more information.Copy of SAC determination letter must be (MCES) submitted prior to Building Permit issuance. Certification/Acknowledgement — A Certificate of Occupancy must be requested and issued prior to use or occupancy of work permitted. Work must be inspected before it is covered,24 hours notice is required. This permit shall be void if the work authorized is not commenced within 180 days of the date of issuance or if work is suspended for a period of 180 days. Term of permit is 12 months from date of issue. This permit may be revoked at any time for due cause or violation of any Federal, State or local law. Applicant agrees that if a permit is granted, all work and materials used shall comply with the City Code of Long Lake. X Applicant Signature Z.--Zu ,7Applicant Is: [ ]Owner [X]Contractor Date 9-2(-/7 Permit Fee Calculation Standard Permit Fees SAC&Sewer/ Water Charges (IF APPLICABLE) Permit Fee $ MCES SAC Charge- Units / SAC Credits-_Units Plan Check Fee $ Net SACs- Units @ $ = $ State Surcharge $ Sewer New Main Line Service Tap $ Penalty $ Water New Main Line Service Tap $ Other(DESCRIBE BELOW) $ Sewer Access Charge $ i J V O • n Water Access Charge $ TOTAL DUE $ TOTAL DUE $ ( I 6 0-79 -OV Code Analysis Occupancy Type of Construction Occupancy Load Use of Building Building Area: Existing SQ FT New SQ FT n Y ♦ � i ' apt yl' J ,.- F � Y J I' 1... "4 1 J> r• ,� . .r', ,,,sf,r1/` y` iTf• A ( Ir a y '.�, K �• , vg: ij ' V* ♦ 4' p`i 1 r 4,-1.- , I j . i.. 1 ;1 ! � �. t a II ' R I fi• ,p, ,,4 -,--'..• �. 4, ,ate ,. I ` _ �. N , .�.,? , a' ♦ .., �4, �,, t, - -c1* 4414* P'''' 7 ,;-1P 1` J of C 1 `f !�'l ,` .tea j �' �(/ rJ 3j,,, �� /tyy._ Vr'\ .,�• f .m . ‘4441:61: ' ,r r • J k 44 R I 51 — v. t. . . 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