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HomeMy WebLinkAbout2015-01506 - sewer disconnect 4110k. CITY OF ORONO I 11 II I 1 11 1 F 2750 KELLEY PARKWAY * 20 1 5 - 0 1 50 6 DATE ISSUED: 11/25/2015 ORONO, MN 55356- . (952) 249-4600 FAX: (952)249-4616 ADDRESS : 190 ORONO ORCHARD RD S PIN : 02-117-23-21-0009 LEGAL DESC : ORONO ORCHARDS : LOT 048 BLOCK 000 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION NOTE: SEWER DISCONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 VIEHL EXCAVATING STATE SURCHARGE SEWER&WATER 1.00 P O BOX 295 TOTAL 51.00 PRIOR LAKE,MN 55372- Payment(s) (612)819-8367 CHECK 10783 51.00 Minnesota State License#: SW-PB644033 OWNER BRUNELLO,JOHN 7513 MAPLEWOOD DRIVE MAPLE GROVE,MN 55311- 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. sir CZ-5—/Z5 Ap'+i ;4 t Permttee S ure Date Issued Signature Date p • FOR CITY USE ONLY ilLO�o\; City P.OBofOrono Date Received: Permit l 2750 Kelley Parkway 0 In-House SAC Determination Form Completed x� Crystal Bay,MN 55323 �rkEsi+o��c (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 further review and may not be_fasaed when the anolication 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) 0 New Connection ❑Additional Connection ❑Re-Connection 0 Repairs 13<connect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address: i 9 v CD ?`Or-46t Owner: -ISROV &D Z-2-GMailing Address: I(o ) S4 / 46 City: (5\tbA- ) Zip: ES3/l Home Phone: 194 65.1).-- --d(00 Alternate Phone: 4c) -o3/ -614145 6 Contractor Information: Contractor: Vo &Lp cdV �/ 7,1e,ez, 16hLt,lL'SC � ua� Contact Person: Address: Y 'O - Po' 9'2s State License#: City: fbJ Zip:°-3 e xpiration Date: /b //a/sV/S' Phone: l2(9 -N q - 8a ? Alternate Phone: C. 1-1-. fire 14(ici, 677Yea- RP (g)36 -p- pi4r0 Pir - /004'5 60 1 p E ((/go `_?3 • 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 sewer connection permit will not be issued) / (�'�wer Connection4 sconnec Repair($50.00/Per Stub) $ 5o.0 0 Pipe size inches;material 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: $ &C.) . `� v 2. STATE SURCHARGE $ 1.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.002. 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ 5/ v` v 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. Applicant: Date: C / ��% ." ":4 DATE TIME CITY OF ORONO CALLED IN 0.-14-. INSPECTION Nf�ICE L� SCHEDULED 12/L O/I /I ©0c4,yi PERMIT NO. b&) )'C�E Q COMPLETED ADDRESS 1 CircrrID rc4/1 c) Cr1f i OWNER TELEPHONE NO. (0t2--9( 4 -. 9. 4 CONTRACTOR 1--)� ,o E�,Lo v DESCRIPTION S__e_k���' 01 SCS G�1VY1c- W ❑ FOOTING 0 DEMO-FINAL 0 SEPTIC FINAL Q ❑ POURED WALL 0 PLUMBING RI 0 EXCAV/GRADING/FILLING y0 ❑ 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 is ❑ INSULATION 0 WOOD BURNER/FIREPLACE 0 COMPLAINT Q 0 FINAL 0 WATER HOOK-UP 0 FOLLOW-UP laj ❑ AS BUILT-SURVEY 0 SEWER HOOK-UP 0 FOUNDATION/REMOVAL .1 ❑ DEMO-SITE ElS PTIC INSTALL <--- OWNER/CONTRACTOR TO MEET YOU: YES_NO t0.0 COMMENTS: it Q. L" ,9s�4i,'-cs p„f,e, cly,Li d j 0 c. 0 4. W CC Q W Z W CC d J/ WU WORK SATISFACTORY:PROCEED et PROJECT COMPLETE W 0 CORRECT WORK&PROCEED /0 ISSUE CERTIFICATE OF OCCUPANCY O 0 CORRECT WORK,CALL FOR REINSPECTION TEMPORARY C.1 BEFORE COVERING PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. 0 PHOTO TAKEN INSPECTOR WILL RETURN 0 O STOP ORDER POSTED.CALL INSPECTOR CITATION ISSUED ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Call for the next inspection 24 hours in advance. (952) 249-4600 Owner/Contractor on site: D ,r 71 %cks Inspector. SL's` White Copyllnspector's File Canary Copy/Site Notice