HomeMy WebLinkAbout2016-01420 - sewer repair � _ CITY OF ORONO * 2 0 1 6 -�0�1 4 2 0 *
2750 KELLEY PARKWAY DATE ISSUED: 1U09/2016
ORONO,MN 55356-
(952)249-4600 FAX: (952)249-4616
ADDRESS : 2715 PENCE LA
PIN : 21-117-23-32-0007
LEGAL DESC : CARMAN BAY HEIGHTS
: LOT 002 BLOCK 001
PERMIT TYPE : SEWER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : REPAIR
NOTE: SEWER REPAIR
APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00
STATE SURCHARGE SEWER&WATER 1.00
ASAP UNDERGROLTND TOTAL 51.00
2355 FAIRVIEW AVE Payment(s)
ROSEVILLE,MN 55113- CREDIT CARD 2636 51.00
(612)222-5502
OWNER
HARRIES,M.SCOTT&LISA
2715 PENCE LA
EXCELSIOR,MN 55331-
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 dces
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances goveming 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 riod of 180 days at any time after work has commenced.
The applicant' esponsible for uring all required inspections aze
requested i o formance wi th State Building Code.This permit may be
revoked at n t' for due au .
/ � / � - � �/� � � `,�
App' a rmitee Sign r Date Issued By Si ture Date
. �
Cl't'Y U�OIYLY
���0 City of Ornno Dau tt«xi�eed: Pefmit#
P.O.Box 66
2750 Kelley Parkway �In-Honse SAC Deteimination Frnm Completed
a �- Crystel Bay,MN 55323
�`"�'�AESHo¢``�` (952)249-4600/Fax(952)249-4616 Approved By(IfRequired�:
CITY OF ORONO—SEWER&WATER/GENERAL PERMIT
(*Noh:Some peamits may require approvai by the Building Official and/or Public Works Departrnent+)
(ALL PERM11'S- Mav be sobiect to fnrthv review and mav not be issued when ffie aoolieNne i:rr�.�.a�
Gfil'�iERAi,IlVFORMATIOI� .
1. You may apply for utility permits by mail or in petson 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 yoa receive a permit card.
4. Work must not begin unless the permit card is available on the job site.
S. Utility connection permits may be issued to licensed contractors only.
6. Contact the Public Works Department(952-249-4600j for utility stub as-built locations.
DO NOT EXCAVATE IN ANY ST1tEET AND DO NOT TAP ANY MAIN withont ezpress
approval of the Pubtic Works Department. Issuance of a permit dces 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 notiee required.
' TY�E O�PE�T
Check All That A i.. .
�esidenrial(May Require Approval) ❑Commercial(Approval Required)
� t
❑New Connection ❑Additional Connection ❑Re-Connection �Repairs ❑Disconnect
❑ Water Availability Connection For Future Hook- p to Water
Jo� Site/C)vvc�Er infor�ation:
Site Address: a 7/S ��l`�C�� L�
Owner: �1�`�� .J��21�r� Mailing Address: .
City: (�l2 D I'�C� Zip:
Home Phone: �o�z-38y"�'7U� Alternate Phone:
�
Contrac�or Information: �
.
Contractor: �i4P v,v�����zvc�D Contact Person: T�N�-t �l�t�i��
Address: �3�s�'2✓1C� f� State License#: �C (����1 z �
City: �i oSe v���e Zip:S�/�3 Expira.tion Date: /-2` 3/�/7
Phone: �,Q �2- 2 z 2���z Alternate Phone: ���� y�3"3�yl
,
� .
I�]E�:F�IVI��TC�1�ER�I?'FE�
❑SAC Charge(2015 Rate=52,485.00) $
(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 Connection/Disconn air .00/Per Stuti) $
ipe size inches;material cl�ir tested; cast iron
❑Water Connection/Disconnect/Repair($50.00/Per Stab) $
Pipe size inches;material Schd 40 sir tested; copper
❑Water Availability For Future Hook Up to Water($50.00) �
Water Availabilitv Eznlanatlon:
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&Hom Pernut
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 S 1.00
3. POSTAGE&HANDLING(Only on Mail-In Applicarions) S 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
ADDITIONAL INFORMATI03�T-V�ATER METERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a senarate 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 .
�innesota, and certifies at all statement e on this application are,true and rrect.
, l� 9 /�
.nt: Date:
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�� TIME
CITY OF ORONO CALLED IN
IN$P6CTION OTICE SCHEDULED �./-�-/(o �Z� O
PERMIT NO D!(a�i�� COMPLEfED
aooAEss a�� 5 �� I�-+n�
p�WNER TELEPHONE NO. 5� "7��r 7D��
CONTRACTOR S � ���-
� DESCRIPTION
�y ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
� ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS
� ❑ INSUUITION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
� ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
W ❑AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATtON/REMOVAL
_
r ❑ DEMO-SITE ❑ SEPTIC INSTALL
� O�WNERICONTRACfOR 7�0 MEET V�IY._Y68_NO ) ♦
� COMMENT� � I� �'l �1 i � C�7 S
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�/��RK SATISFACTORY:PFiOCEED �PFiW ECT COMPLETE
W O OORfiECT W�ORIC d�PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
O p�ECT yyppK,(,ALL FOq REINSPECTION TEMPOfiARY
V BEFORECdVERIN� PERMANENT
❑ppFiREC'TUNS/1FEOONOITIONWITHIN HOURS.�TOTAKEN
INSPECfOR WILL RETURN � ���..rJ
❑8TOP ORDER P08TED.G1LL INSPECTOR �qTATION ISSUED
O INSPECTIOM REOUIRED.C/1LL TO ARFiAN(iE ACCESS.
csN t�me next�s�ect�on u nours h e�►m,os. (952) 249-4600
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