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Home My WebLink About2014-00420 - sewer/water repair . � CITY OF ORONO * 2 0 1 4 - 0 0 4 2 0 * r 2750 KELLEY PARKWAY DATE ISSUED: OS/08/2014 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 1966 SHADYWOOD RD PIN : 17-117-23-24-0024 LEGAL DESC : SHADY-WOOD ; LOT 036 BLOCK 000 PERMIT TYPE : SEWER& WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : REPAIR N07�L-:: Rl?PAIR WATF.R SE:RV[CE? APPLICANT WATER CONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER& WATER 5.00 J P SCHMIT7.CONS`CRUCTION COMPANY LL TOTAL 55.00 16450 117TH AVE N MAPLE GROVE, MN 55369- Payment(s) CHECK 11566 55.00 OWNER OLSON,JACK& KARI 1966 SHADYWOOD RD WAYZATA, MN 55391- AGREEMENT AND SWORN STATEMENT The��ork for which this permit is issued shall be perlormed according[o the approved plans and specifications,applicable City approvals,and the State Building Code. This permit is for only[he work described and does not grant pennission 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."Chis 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 da}�s at any time atter work has commenced. The applicant is responsible for assuring all required inspections are requested in conformance with the State Building Code.This permit may be revoked y ti for due e. / / App i er ee Signature Date Issued 13y Si � ture Date f , ~ , i5 (� � > �r.. FOR CITY USE ONLY ;�'� ��`: �;��-- y� � Cl�Of�COriO Date Received: Permit# �`` ' P.O.Box 66 `i ' 2750 Kelley Parkway ❑In-House SAC Determination Form Completed t 1\� k � Crystal Bay,MN 55323 �� ✓�`�, �� (952)249-4600/Fax(952)249-4616 Approved By(If Required): ��''' CITY OF ORONO— SEWER& WATER/ GENERAL PERMIT (*hote:So�ne pennits�nay require approval by the Buildine Official and/or Public Works Depamnent*) (ALL PERMITS- Mav be subiect to further revieN and ma�not be issued when the appGcation 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 return 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 EXCAVATE 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+hour notice required. TYPE OF PERMIT (Check All That A 1 ) �Residential (May Require Approval) ❑ Commercial(Approval Required) ❑New Connection ❑Additional Connection ❑Re-Connection „�Repairs ❑ Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address: � /(Q,�J S��C�Z�1 �L�� Owner: �,1�r7�'( vG��"�' Mailing Address: /11(l� �`J/�� City: �l�C�'l�� Zip: Home Phone: Alternate Phone: Contractor Information: Contractor: -7r��l�� '�'�%� Contact Person: ��1� -%C�/�C��— Address: �+�7�� /�'�`� State License#: �[�7.�� City: ��/�� Zip:��'� Expiration Date: � Z 5 � �� 7�,-�/ c� � Phone: 7��. !��6 `�<�✓ Alternate Phone: . DETERMINING PERMIT FEES ❑ SAC Charge(2014 Rate=$2,485.00) $ (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;material Schd 40 air tested; cast iron �Water Connection/Disconnec /Repair $50.00/Per Stub) $ Pipe size inches;materia chd 40 air tested; copper ❑Water Availability For Future Hook-Up to Water($50.00) $ Water Availabilit�-Explanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Department. Required Before Water Connection Permit is Issued: 1. Issue Water Meter&Horn Permit 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Connection Permit: L Collect Permit Fee&Issue Water Connection Permit 1. SUBTOTAL of Permit Requested: � 2. STATE SURCHARGE $ 5.00 3. POSTAGE&HANDLING(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 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 1 atements made on this application are,true and correct. .�''- i Applica . � Date: ' ��