HomeMy WebLinkAbout2007-P11017 - seewer/water repair PERMIT
CITY �F ORONO
275CtKelley Parkway- PO Box 66 Permit Number: p11017
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Pernut
(952) 249-4600 Date Issued: 5/18/2007
SITE ADDRESS: 1880 Shadywood Rd Unit#
Wayzata,MN 55391
PID: 17-117-23-24-0004
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type:
Sewer and Water Permit Permit Sub-type(s): Sewer/Water Repair
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
Repair Only- SAC Grandf In#1097-04/26/66
FEE SUMMARY: Permit Fee: $ 35.00 Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Blaylock Plumbing Co. OWNER: Durwood Taylor
7731 -4th Ave S 1880 Shadywood Rd
Richfield,MN 55423 Wayzata MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
M[NNESOTA BUILDING CODE REQUIREMENTS.
�.�� . -
, ,;
"'t ��� _
� � �- �1 �- � ' C,�"�� ���
,
APPLICANT PE E SIGNATURE ISSUED BY SIGNATURE �
Copies: 1-File(SignaturesRequired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septiq 1-Septic) Page 1
,
.
FOR�ITY U"SE UATLY
�d� City of Orono 1)ace Receivod: '�Pv�mic# '
P.O.Box 66
��v,, a 2750 Kelley Parkway �In-Hfluae SAC beferminatioa�otm Cc3mpletal
� � F„� Crystal Bay,MN 55323
" (952)249-4600 ved Hy{If R
� � �n��`
CITY OF ORONO-SEWER&WATER/GENERAL PERMIT
(*Note:Some permits may require approval by the Building Official and/or Public Works Department•)
(ALL PERMITS- Mav be subiect to furt6er review and mav not be Issued when the soolicatlon is received)
GENERAL"TNFURMATI�N '
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 return mail within 2 business days.
3. Permits are not valid until you receive a permit card.
4. Work must not begin unless the pelmit 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 EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without ezpress
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+hour notice required.
TYFE OF P'ERMIT
Check Ail'I"hat A" 1
�Residential(May Require Approval) ❑Commercial(Approval Required)
�New Connection ❑Additional Connection �Re-Connection �Repairs ❑Disconnect
: Jab Site/C3wner Tnformation: ''
Site Address: �
Owner: ���Lw� �J'YI�'u � Mailing Address: ��'�� � �0�.
City: �I Z.f!"i2.� Zip: � � �
Home Phone: �a/�2 ,�100��o��� Altemate Phone: ��� — ��/��� �
,
Contractor Infarmation:
Contractor: � �� �ontact Person: �
Address: �7J' / —Y���0 . State License#: S�Q (D ��
�
. � � ,� ��_a 7
City: Zip�� xpiration Date:
Phone: �D�-Z ��7� 7J�3 � Alternate Phone:
.
.
���'�-z �� �v� �` � .,.w: ,•,,,... -: t���k�� � ��- t��
=�2, � �T�. �, ���e ...�, s � 't
�SAC Charge(2007 Rate=$1,675.00) $
(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($35.00/Per Stub� $ �c�, �(�
Pipe size inches;material Schd 40 air tested; cast iron
❑Water Connection/Disconnect/Repair($35.00/Per Stub $
Pipe size inches;material Schd 40 air tested; � copper
1. SUBTOTAL of Permit Requested: $
2. STATE SURCHARGE $ .50
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ _ -
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ` c_7 •� �
�.UDI'T'IO�+TAL TNFORMATIf)N`—WATER METERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a sepazate 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,and certifies that all statements made on this application are,true and correct.
Applicant:� ✓ , ( Date: �l���
�° fr�: � ��
t �� �
3.w .. �... � ��.�