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Home My WebLink About2010-00075 - sewer disconnection r ' CITY OF ORONO PERMIT NO.: 20�0-000�s 2750 KELLEY PARKWAY ORONO, MN 55356- �ATE IssuEn: 02/1U2010 952 249-4600 FAX: 952 249-4616 ADDRESS : 2655 SHADYWOOD RD PIN : 21-117-23-23-0023 LEGAL DESC : PHEASANT LAWN : LOT 000 BLOCK 000 PERMIT TYPE : SEWER& WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION NOTE: WA"I�ER&SLWER DISCONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 EXCAVAT[NG SERVICES WATER CONNECT/DISCONNECT/REPAIR 50.00 22703 WINCHESTER TR CORCORAN, MN 55340- STATE SURCHARGE SEWER& WATER 0.50 (763)498-8319 TOTAL 100.50 OWNER HADDEN, JUL[E&TIM 2655 SHADYWOOD RD EXCELSIOR, MN 55331- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specitications,applicable City approvals,and the State Quilding 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 it�construction is suspended Yor a period of 180 days at any time after work has commenced. The applicant is responsible for assuring all required inspections are requested in conforman i[h the State Building Code.This permit may be revoked at any tim or d e cause. `�. L , J l , ,o p�, // , a o�v Applicant Permrtee Signature Date Iss By Signa re Date SEPARATE PERMITS REQUIRED FOR WORK O HER THAN DESCRIBED ABOVE. FOR CIT USE ONLY O¢�A�O City of Orono Date Received� Q Pemiit# ��Q� �Q 7� �r P.O.Box 66 2750 Kelley Parkway ❑In-House SAC Detenninalion Form Completed � l '• � Crystal Bay,MN 55323 o` (952)249-4600 Apprwed By(If Requued): �R�o�� CITY OF ORONO—SEWER&WATER/GENERAL PERMIT (•Note:Some pecmits may require approval by the Building Official and/or Public Works Depattment*) (ALL PERMITS- Mav be subiect to f�rther review and mav not be issued when the aoolication 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 retum 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 EXCAVA'I'E 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+bour notice required. TYPE OF PERNIIT (Check All That A 1 ) Q Residential(May Require Approval) ❑Commercial(Approval Required) ❑New Connection ❑Additional Connection �Re-Connection ❑Repaus Q Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: � �Site Address: �' 6 �S � � ��- � f� Owner: ��Gt�c��-�ij-+ Mailing Address: /1�w�s- City: �/�o� Zip: Home Phone: Alternate Phone: Contractor Information: Contractor: �� Contact Person: �i"�"' � Address: z z 7�3 W-�.•.c�l�ce..�c�7�� State License#: City: Zip:s5�3�o Expiration Date: Phone: 7G 3 �9 8 8'3/9 Alternate Phone: 6�Z g6 g 8'°72 �Cv.Q�I / DETERMINING PERMIT FEES �SAC Charge(2009 Rate=$2,100.00) $ (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($50.00/Per Stub) $ Pipe size inches;matenal Schd 40 air tested; cast iron ❑Water Connection/Disconnect/Repair($50.0(1/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 Departrnent. Reauired Before Water Connection Permit is Issued: 1. Issue Water Meter&.Hom Permit 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Connection Permit: L Collect Perniit Fee&Issue Water Cormection Pertnit 1. SUBTOTAL of Permit Requested: $ Z. STATE SURCHARGE $ .50 3. POSTAGE&HANllLING(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 neimit. ■ 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 regularions of the State of Minnesota,and certifies that all statements made on this application are,true and correct. Applicant: �G�-►,r► ��-aG`� Date: . Reset Form � � �� TIME Y OF ORONO LED IN d � l� INSPECTION OTICE CHEDULED / C/•'d� PERMIT NO. — OMPLETED ADDRESS OWNER CONTR. TELEPHONE NO. f �� O � �S ^ �D 7 � � DESCRIPTION `-�`��' ��SC � ❑ FOOTING ❑ MECHANICAL RI ❑ EXCAV/GRADING/FILLING y ❑ FRAMING ❑ MECHANICA�FINAL ❑ LAKESHORE/WETLANDS O ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ TREE REMOVAL Z ❑ WALL BD. ❑ WATER HOOK-UP ❑ SITE INSPECTION Q ❑ FINAL ❑ SEWER NOOK-UP ❑ PROGRESS � ❑ DEMO-SITE ❑ SEPTIC MAINT. ❑ COMPLAINT v ❑ DEMO-FINAL ❑ SEPTIC INSTALL. ❑ FOLLOW-UP ' i ❑ PLUMBING RI ❑ SEPTIC FINAL p HARD COVER REMOVAL J ❑ PLUMBING FINAL ❑ FOUNDATIOWREMOVAL � OWNERICONTRACTOR TO MEET YOU:_YES_NO � COMMENTS: � W a J O � � O � ti � Q � 2 W � W � � � ��ORKSATISFACTORY:PROCEED ❑ PROJECTCOMPLEfE W O CORRECT 1MORK 8 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY 0 ❑CORRECT U�IORK,CALL FOR REINSPECTiON TEMPORARY V BEFORECQVERINC., PERMANENT ❑CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN INSPECTOR WILL RETURN ❑CITATION ISSUED ❑STOP ORDER POSTED.CALI INSPECTOR ❑INSPECTION RE(]UIRED.CALL TO ARRANGE ACCESS. Call forthe next inspection 24 hours in advance. (g52) 249-4600 OwnerlContractor on si � � � Inspector. „�� ' White CopyMspector's File Canary CopylSite Notice