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Home My WebLink About2011-01021 - sewer disconnection CITY OF ORONO PERMIT NO.: 2011-01021 2750 KELLEY PARKWAY � � ORONO,MN 55356- DATE ISSUEn: 09/07/2011 952 249-4600 FAX: 952 249-4616 ADDRESS : 925 PARTENWOOD RD PIN : 08-117-23-21-0010 LEGAL DESC : PARTENWOOD : LOT 001 BLOCK 003 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 OLSON CONSTRUCTION CO. STATE SURCHARGE SEWER&WATER 5.00 6970 INWOOD ROAD TOTAL 55.00 COLOGNE,MN 55322- (952)448-6674 Minnesota State License#:L1111 OWNER SAFAR,MARY 925 PARTENWOOD RD 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 sepazate 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 e State Building Code.This permit may be rev ked y time for due a se. r / / / / pplicant Permitee Signature Date Issued By Sig ure Date . SEPARA PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB E. FOR CIT'Y USE ONLY 'O¢p�O City of Orono Date Received: Permit# P.O.Box 66 2750 Kelley Parkway ❑In-House SAC Detennination Form Completed '� r+'�• ; Crystal Bay,MN 55323 ��,, `o (952)249-4600 Approved By Qf Required j: s�xo8 CITY OF ORONO—SEWER& WATER/GENERAL PERMIT (•Note:Some permits may require approval by the Building OfYicial and/or Public Works Departrnent') (ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoplication is received) GENERAL INFORMATION 1. You may apply for utiliry 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 wili 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 A 1 0■ 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/Owner Information: s�te aaa�ess: 925 Partenwood Rd Owner: Mailing Address: Orono City: Zip: Home Phone: Alternate Phone: Contractor Information: Olson Construction Ronald Olson Contractor: Contact Person: 6970 Inwood Rd 075033-RP Address: State License#: Cologne 55322 City: Zip: Expiration Date: 952-448-6674 612-369-4240 Phone: Alternate Phone: DETERNIINING PERMIT FEES ❑ SAC Charge(2011 Rate=$2,230.00) $ (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 Connection Disconnect Repair(550.00/Per Stub) $50.00 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 Availabiliri Explanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Department. Reauired 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: $50.00 2. STATE SURCHARGE $ 5.00 3. POSTAGE&HANDLWG(Only on Mail-In Applications) $ ?:'99 4. TOTAL PERMTT F'EE(Add Lines 1-3 Above) $55.00 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 ineter 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 conect. , � Applicant: Date: � � Reset Form � � � '�a��9 �'�`� �„� � .7 ` � � � . .is,,' J /�i�x..��ri� � � W. r : � �J - �. .:- � ,j,�;�'y � _ , � ;'� ,�' ; .:�.,�..r_ , . k�, r. �r�'� • , � �- a �� f : e � �. �,�/` 4� `,, �� } � � ��.��%�' �� `1 - � , ca' ��.1 +� 11 :✓:. 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S'?- � �- 7� CONTRACTOR �" �u�� DESCRIPTION v�-�� l S � � � ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING Q ❑ POURED WALL ❑ MECHANICAL RI � LAKESHORFJWETLANDS y ❑ FRAMING ❑ MECHANICAL FINAL Q ❑ TREE REMOVAL Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION Q ❑ RADON SLAB ❑ WATER HOOK-UP ❑ PROGRESS � 0 FINAL ❑ SEWER HOOK-UP ❑ COMPLAINT J ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP i ❑ DEMO-FINAL 0 SEPTIC INSTALL ❑ HARD COVER REMOVAL J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDAT�OWREMOVAL � OWNER/CONTRACTOR TO MEET YOU:_YES_NO c�., COMMENTS: � a � � O �. � O � W � Q � 2 W � W � � � d � �K SATISFACTORY:PROCEED ❑ PROJECT COMPLETE W ❑CORRECT WORK&PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY V BEFORE COVERING PERMANENT ❑CORRECTUNSAFECONDITIONWITHIN HOURS. p pHOTOTAKEN INSPECTOR WFLL RETURN ❑CITATION ISSUED ❑STOP OfiDER POSTED.CALL INSPECTOR ❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS. Ca11 for the next inspection 24 hours in advance. (g52) 249-4600 OwnedContractor on sit : � Inspector. � White Copyllnspector's File Canary CopylSite Notice