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HomeMy WebLinkAbout2015-00612 - sewer/water connect CITY OF ORONO * Z 0 1 5 - P1 0 6 1 Z * � 2750 KELLEY PARKWAY DATE ISSUED: OS/15/2015 ORONO, MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 683 SANDSTONE CIR pIN : 33-118-23-11-0043 LEGAL DESC : STONEBAY : LOT 040 BLOCK 001 PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTIOPI TYPE : CONNECTION NOTE: SAC PERMIT#2015-00264 03/03/15 APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 WATER CONNECT/DISCONNECT/REPAIR 50.00 J.S. STEWART COMPANIES STATE SURCHARGE SEWER&WATER 5.00 11030 LAMONT AVE HANOVER, MN 55341 TOTAL 105.00 (763)424-9030 Payment(s) CHECK 6252 105.00 OWNER Stonebay Builders LLC 14870 BROCKTON LANE DAYTON, MN 55327- AGREEMENT AIYD 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 t Stat Iding Code.This permit may be rev at any ime for due c se. _ �"'_ � � c�=r -1 � ►��- � �.�,-,-��f �� � , � � , ,�- _ icant Permitee Signature Date Issued By Signature Date � � ���c I�d �!3 rs`. ��,��j,�,p��� � I — FO�USE ONLY ,7 r /_�'Z y�-��/� City of Orono Date Received: Permit# G��J—�/ l(J �1 P.O.Box 66 �� �. 2750 Kelley Parkway ❑in-House SAC Determination Fortn Completed Crystal Bay,MN 55323 ��`�"` (952)249-4600/Fax(952)249-4616 Approved By(lf Required): i �� ` 'ar�:;�. C1TY OF ORONO-SEWER& WATER/GENERAL PERMIT (*Note:Some permits may require approval by the Building Officiai and/or Pubtic Works Depanment') {ALL PERMITS- M�v be subiect to further review and mav not be issued when the a�olication is received) GENERAL iNFORMATION 1. You may apply far 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 return mail within 2 business days. 3. Permits are oot valid until you receive a permit card. 4. Work must not begin unless the pernut card is availabte on the job site. 5. Utility connection pernuts may be issued to licensed contractors only. 6. Contact the Public Works Department(952-249-4600)far utility stub as-built locations. DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY iNAIN 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. Cail(952}249-4600,24+hour notice required. TYPE OF PERMIT Check All That A 1 �Residential(May Require Approval) ❑Commercia!(Approval Required) I � New Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect ❑ Water Availability Connection For Future Hook-Up to Water � Job Site;Owner Information: Site Address: 4��3 �C�.��s�y�� (�2�� ,C _ Owner:� �� � � j (, B��'"� Mailing Address: � � �� 7 C? �, V�iL�C,1DY[ f Gt,K� c�ty: i�i� z�p: S S 3z � Home Phone: Alternate Phone: -7�� ' �7� - G:����(�.� Contractor Information: Contractor: ����J`��-✓�l.� ��� Contact Person: �a�S ��'F�wu,V+— Address: ����� ��1�1�n�'I��./1/� State License#: City: ;�t,'vl,�l'�.,�� Zip��l Expiration Date: Phone: ?� '� `f�`E-���d Alternate Phone: (v I Z ?�;�� (;��,���j f r � DETERMINING PERMIT I'EES �AC Charge(2015 Rate=$2,485A0) $ (SAC Charge must accompany ali sewer permit applications unless prepaid) (Orono City Staff can determine if applicable) (If not prepaid,a sewer connection permit wiil not be issued) t./L� Sewer Connection/Disconnect/Repair($50.00/Per Stub) $ J� ' Pipe size `� inches;material�-I,�GSchd 40 air tested; cast iron �� (�Water Connection/Disconnect/Re air($50.00/Per Stub) $ �J� � � Pipe size�inches;material � �'��chd 40 air tested; copper ❑Water Availability For Future Hook-Up to Water($50.00) $ Water Availability Exalanation: Contractor installed line to inside of house for future hook-up. This 3ine will be inspected by the Public Works Department. Required Before Water Connection Pemut 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: $ j ��� 2. STATE SURCHARGE $ 5.00 3. POSTAGE&HANDLING(Only on Mail-in Applications) $ 2.00 O 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ j L �— ADDITIONAL INFORMATION—WATER METERS ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a seaarate 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,�fid certifies th t all �tatements made on this application are,trtte and correct. �._--- - _ Applican� , ,'�J Date: S- �5 — / `� / Y = „ .. ,� , - �,,�r�•. uu, y � k � ����ui � � , i� "_« A i r � '.. ��R .. . �. � i j ''�'�i� "�;. " ° ��� '"� ' �.+� :�f rr� � .� � :.. • A J�,�'. . �� ��v ��� k �'V� ^'" � +J�;• ,�„ �y� t .� dwr . ,� i, '- `� "... : ` .� +A +� .il .+w �^. �i � aw ' � ,� ��. - �'+p�IF �x,�"�r. � .. � � ��� r ' LL �Mr�����.� ,�. �„ w� �. ;:. * „ . � y .� . +}5: - �1.4 � 3!-' a". '�'4.' , �s� . � ���'ti ' �.. .�:, . ,r , n � `„ * �; a �� a b � � „ � " �y , � � - . , ` .& , � '# � � ,� ' - - .. ,�r � "�� ,' '`"^'�'` �' v' '�+,1�" � � �- � ,.i` ��' , � �. � - ' �,� . , . ,, y , #� ` '� � ,' x� '-�r � � � t� r� p �, ;� _ �1s' u �M � ,;� �� . 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