HomeMy WebLinkAbout2018-00384 - sewer/water connect ' • CITY OF ORONO * Z � 1 8 - 0 0 3 8 4 *
2750 KELLEY PARKWAY DATE ISSUED: 03/30/2018
ORONO,MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 575 SANDHILL DR
PIN : 33-118-23-24-0013
LEGAL DESC : ORONO PRESERVE
: LOT 6 BLOCK 1
PERMIT TYPE : SEWER&WATER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : CONNECTION
NOTE: SEWER AND WATER CONNECTION
APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00
D.S.M.EXCAVATING WATER CONNECT/DISCONNECT/REPAIR 50.00
2916 ENTERPRISE AVE STATE SURCHARGE SEWER&WATER 1.00
HASTINGS,MN 55033- TOTAL 101.00
(651)480-1355 Payment(s)
CREDIT CARD 5166 101.00
OWNER
OPS Orono LLC
15250 WAYZATA BLVD#101
WAYZATA,MN 55391-
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 sepazate
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 I80 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 aze
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
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Applicant Permitee Signature Date Issu y Signature Date
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2750 Kdley ParkweY �Ip-Hc�nse�AC llebqininad�Form C�pkxed
� Cryatel Bay,MN 55323
����xFsx o¢�', (952)249-4600/Faz(952)249-4616 APP�'�BY(Tf�9u�t
CITY OF ORONO—SEWER&WATER/GENERAL pEI�1VIIT
(•Nots:S�pecmits maY n9�aPP�'+�bY�B��do►8 O�Cisl and/or Public Waks Depsrtmprt•)
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1. You may apply far utiiility peamits by mail ar in person at the City offices.
2. Mailed in appl�catians are subject to the postage and hsadling fee shown below. Permit cards will
� be sent by return mail within 2 business days.
3. Permits are not valid antii.yon receive a permit card.
4. Work must not begin unless die permit card is available on the job sitc.
5. Utility connection permiLs may be issued to lfcensed contractors anly.
6. Contact the Public Works Department(952-249-4600j for utility stub as-built locations.
DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAiiv v►�thout ezpress
approval of tLe Public Worka Depsr�ent� Issuance of a permit does not grant this approvaL
7. All work must be done in accordance wi�State Code roquirements.
8. All work must be inspected befare it is covered. Call(952)249-4600,24+honr notice reqnired.
TYPE OF PER�T �
Chr�k.�ll That A�: .
�Residential(MaY Recluu'e APPI'o�) ❑Commercial(Approval Required)
(� New Connecrion ❑Additional Connection ❑R�Connection ❑Repairs �Disconnect
❑ Water Availability Cannection For Futun Hook-Up to Water
JQ�J �i�P�OVVpLI'�033�38.t1�II:
Site Address: �7� �qi✓�fi�/LL ,��G. .
Owner: �9��0 j✓e�.ku1 f� �S�
� '�' Mailing Address: .
c��: ��oN6 z�p:
Home Phone: Alternate Phone:
Co�trac�or�iiforin�tion:
Contractor: _U,S;�� L��x�`1'Ms�, �N�. Contact Person: �'�� 6d�rQ-�,�6
Address: 29/� ,Q,is� , State License#:
- ,
City: .4.�'ti�✓6S Zip:��� Expiration Date:
Phone: ��� y�e. /dsS Altemate Phone: _�� �/9 f�.t f►'S"
.... _ .
j�'�T R�TC3'�EI�:I'i'FE�S
❑SAC Charge(2015 Rate=52,485.00) �
(SAC Charge must accompany all sewer permit applicadons unless prepaid)
(Orono City Staff can determine if applicable)
(If not prepaid,a sewer connection permit will not be issued)
(�Sewer Connection/Disconnect/Repalr($50.00/Per Stuti) S
pipe size�inches;material� Schd 40 a'v tested; cast iron
(�Water Conn�tion/Disconnect/,R,�e�air($50.00/Per Stub) $
Pipe siu,L_inches;material r""� Schd 40 air tested; copPtr
❑Water Availability For Future Hook-Up to Water(550.00) �
Water Availabilitv E�rnlanation:
Contractor installed line to inside of house for firture hook-up.
This line will be inspected by the Public Works Deparnnent. �
Rcquired Before Water Connection Permit is Issued:
1. Issue Water Meter&Horn Permrt
2. Any Additional Connection Fees Paid(If Applicable)
r��ue Water C��►ection Permit:
1. Collect Permit Fee&Issue Water Connection Permit
1. SUBTOTAL of Permit Requested: �
2. STATE SURCHARGE a 1'�
3. POSTAGE&HANDLING(Only on Mail-In Applicarians) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) s
ADDITIONAL 1NFORMATT03�T-WATER METERS
• WATER METERS must be picked up and paid for at Orono City Hall,these are on a seoarate,permit.
■ WATER METERS must be set and sealed by Orono Water Department (95Z) 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 correct.
Applicant: � Date: 3��,�g