HomeMy WebLinkAbout2010-00162 - sewer connection �.
CITY OF ORONO PERMIT NO.: 2oiaooi62
. 2750 KELLEY PARKWAY
ORONO,MN 55356- DATE ISSUED: 03/22/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 2600 PHEASANT RD
PIN : 21-117-23-23-0023
LEGAL DESC : PHEASANT LAWN
: LOT 000 BLOCK 000
PERMIT TYPE : SEWER&WATER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : CONNECTION
NOTE: NEW WATER AND SEWER CONNECTION
APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00
ABLE EXCAVATING WATER CONNECT/DISCONNECT/REPAIR 50.00
15630 OLD BRICK YARD RD.
SHAKOPEE,MN 55379 STATE SURCHARGE SEWER&WATER 0.50
(952)445-7432 TOTAL 100.50
Minnesota State License#: 994 PAID WITH CC# 4966
OWNER
HADDEN,TIMOTHY&JULIANN
2600 PHEASANT 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 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 consWction is
suspended for a period of 180 days at any time after work has commenced.
The applica�t is responsible for assuring all required inspections aze
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
C���C 3 /s3o2.-r d0/� �.3 / �D/D
Applicant Perm�tee Signature Date Issu By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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(952)249�46Uo 'A BY(�tRequirodl: .,_,•
CITY OF ORONO—SEWER 8t�RTATER GENERAI.�Y �'RNIIT .
(•Nah:Some Pa�ti1s maY raN��+'�bY d�e Buildil�O�iciel a Fablic Waim Depanmeot•), .
G�x�:nr�axr���arr . . . ., . . .:
1. You meY aPPh+for utility pcamits by mail or ia persQn�t , City off ces, �
2.. Mslled in applit�allons ace subjcct to i�he postage snd ng fee shown below. Permit cards will
, be se,�t by retum mail within 2 bustness days.
3. Permita are not v�lid untlt yon ruxivc s perm[t card.
4. Work must nat be�in�mleas tl�e pamit oard is availnble the job.sibe.
s. Utility co�ctia�pamit9 may be issued to licea�sed oms oniy. � �
6. Co�rtact tha Pubiic Works L)eparmnent(952-249�4600)for Hlity stub as-built loc�tions.
DO�10T EXCA'VATL�N ANY 5TREET AN'D DO N TAP ANY MA1N withoht e�cpresa
approv�l ot the Poblic'Works Depautment. Issuano�o permit.does not grant this appe�aval. .
7. Atl work mnst be do�in accordance with Stete Code . .
8. A[1 work must be'inspected bofote it is cove[ed. Ca1l(95� 249-4b00,24+6our�notice reqoired.
. � � �'YPE OF�fi1t1�IIT�: � . � � , .
, � � � �heck:t�ll��That . ' �;L�. . � � �, ... .
� �Residential(May Require Apptoval) ❑Commerc (Appro�al Required) .
❑New Cdnnection ❑Additional Connection �RaCo 'on Q Repaus � Q Diseonnecc
' ❑ W'ater Availability Conn�ctiaa FatF � t�c I-1�o1G Up to Water •
Job S}te/Owner.Information: . . � � .
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Site�Address: �f e�,S h 7� . . .
Oomer: ��Ei��'� Mailing A,dress:9.33� �L%� /��r 1�, G1� /�! .
city: �'/,��� �d 0 �/�. zip: /y�JIQ �so �.- �3'3'3�/.
Home Phone: Alternate hone: � 6��"" �i�g'-�60�
Coniiractor Information:. � �
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Contra�ctor. ��.,/� ��K. �` , COntact n: r� � . .
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Address: /�l��d'l D/�1,�YE��yr�r'�£Sta�e Lice se#: B 77 9'�'2 "/Q�
. � city: �' �i.��� zip:�S379�xpirati Date: .. � . .
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Phone:.9'�d2- y y�= � �3� Aiternate ane: �12�� �3�—/y fr`1�
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❑SAC C6arge(201Qltste=$2,100.00) �s '
(SAC Chargt must accompany all sewer permit appG�tions untess preFaid)
(Orono City 3taff can debarmina if applicable) ;
(If not prepsld,a.sewer c�decrion petmit wfll not�e bsaot� ' .
f�&+w�Co�e�t�or1/Dt8Coa4ect/S�epe�(S50.00/Per� b) S � ,�� r
Pipe sine 7 inches;mate�ia! v`. Sdtd 40 air te�d; cast iron
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,�V1�aber eanue�tion/Dlsconqtet/ r($50.09 b), S ��
con '
Pipe size�,'�inches:tna�a�al✓' �Schd 40 air ; �PP�' . .
��dre��ee., .
❑Water Avail�bility For�'ntnre Aook-Up to Water(3�SOA0) $
� . . •
. . VV ter�Avsilabilitv E nl�a�tion: �
Conhgdor installed line to inside of f�duse for fuduo k-up. '
This line�+vil1 be inspected b.y tlae public Works Dep t� �
R�uired Befor Water Coimecaon Permiti�ssued: .
1. Issue Watet Meter 8t Harn Permit
2. Arry Additional Connectioa Fers Paid(�f A licable) � �
Issue Water C an Pennit� �
x. Collect�ermit f'ee&Issue W�tar Cannectin Permit �
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1.�SYJ'BTOTAL of Pertnit Requosted: � $ � � • l��•
2. STA7'E SURCI3AROE � $ ' •��
3. POSTAGE&I�CANDLING(Only on Mail-In Appiicat�ons) $� Z QQ
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4. TOTAY,P'ERMIT FEE(Add�.iues 1-3 Abo�e) � S 1�•��
. �nnrt�or.tar,�n�rFo�ta�orr-�� , .���:���r��s.� �
■ WATER ME7'ERS must be picked up and paid for at Orono: ity Hall,it►ese ara o�►a sepa�per i .
■ 'WATEYt 11�TERS ma't be set And sail�d by Orono W De�ewr�mt.(952)249=46fl0, apon �
� complrtlon ot mehr iostalhtloa ,
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The unctersigned hereby applies to the City of Orono for iss df a LTtility Permit,agrees to do
all work in�sirict accordance with the ordinances nf the Ci and t�e regulations of the 3tate of
Minnesota,a�ad aertif�es that all statemeMs made on this 'on are,lrue'and cotrect. .
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Applicaut: ' Daie•
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L ^� � �� DAT TIME v
CITY OF ORONO CALLED IN c3 d
INSPECTION O ICE /� SCHEDULED �d �
PERMIT NO. ��O--DD�j�s'1 COMPLETED
ADDRESS ��P� �`1�-a-Gl�` �2�—
OWNER TELyE�P QNE NO. ��� — �-
CONTRACTOR G��1L�L ' � �
� DESCRIPTION �'��� � ����L
� ❑ FOOTING ❑ PLUMBING FINAL ❑ EXCAV/GRADING/FILLING
Q ❑ POURED WALL ❑ MECHANICAL RI ❑ LAKESHORENVETLANDS
y ❑ FRAMING ❑ MECHANICAL FINAL
Q ❑ TREE REMOVAL
Z ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ SITE INSPECTION
Q ❑ RADON SLAB �WATER HOOK-UP ❑ PROGRESS
� ❑ FINAL 1�SEWER HOOK-UP ❑ COMPLAINT
J � DEMO-SITE ❑ SEPTIC MAINT. ❑ FOLLOW-UP
i ❑ DEMO-FINAL ❑ SEPTIC INSTALL ❑ HARD COVER REMOVAL
J ❑ PLUMBING RI ❑ SEPTIC FINAL ❑ FOUNDATION/REMOVAL
� OWNER/CONTRACTOR TO MEET YOU:_YES_NO
y COMMENTS:
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� O WORKSATISFACTORY:PROCEED /��PROJECTCOMPLEfE
W ❑CORRECT WORK&PROCEED r❑ ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
O CORRECT UNSAFE CONDITION WITHIN HOURS. p pHOTO TAKEN
INSPECTOR WlLL RETURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑INSPECTION REQUIRED.CALLTOARRANGE ACCESS.
Cail for the next inspection 24 hours in advance. (952) 249-4600
OwnedContractor on site:
� r ��Inspector. r�i���
White Copyllnspector's File Canary Copy/Site Notice