HomeMy WebLinkAbout2009-00483 - new sewer/water � y
CITY OF ORONO PERMIT NO.: 2009-00483
2750 KELLEY PARKWAY
ORONO,MN 55356- DATE IssuEn: 08/12/2009
952 249-4600 FAX: 952 249-4616
ADDRESS : 2100 SHADYWOOD RD
PIN : 17-117-23-31-0041
LEGAL DESC : WILEYS PARK LAKE MTKA
: LOT 030 BLOCK 001
PERMIT TYPE : SEWER&WATER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : NEW
NOTE:
SEWER CONNECTION-4"PIPE-SCHEDULE 40
WATER CONNECTION- 1"PIPE-POLY
APPLICANT WATER CONNECT/DISCONNECT/REPAIR 50.00
WESTONKA SEWER&WATER SEWER CONNECT/DISCONNECT/REPAIR 50.00
6501 CO.RD 15
MOUND,MN 55364 STATE SURCHARGE SEWER&WATER 0.50
(952)472-4959 TOTAL 100.50
Minnesota State License#: 58019PM
OWNER
MARHULA,DAREN
2100 SHADYWOOD RD
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 does
not grant permission for additional or related work which requires separate
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 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 aze
requested in conformance with e State Building Code.1'his permit may be
revoked at � e for du e.
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Applicant Permitee Sign re Date Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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�,����� City of Orono T�ate<R�cei�,ed:� � � �Permit-# �
P.O.Box 66
2750 Kelley Parkway [���=k��1�'��C'ID��n��h+m��iorm` 'Gomp3eted �
� �' � Crystal Bay,MN 55323 ° '
� (952)249-4600 �1p��ued�3��Ffite9uire#l� .
CITY OF ORONO—SEWER&WATER/GENERAL PERNIIT
(*Note:Some permits may require approvai by the Building Ofticial and/or Public Works Department*)
(ALL PERMITS- Mav be subiect to further review and mav not be issued�vhen the aoolication is received)
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1. You may apply for utility permits by mail or in person at the City offices.
2. Mailed in applicarions are subject to the postage and handling fee shown below. Permit cards will
be sent by retum 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. Urility 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. Al]work must be inspected before it is covered. Call(952)249-4600,24+hour notice required.
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�Residentia](May Require Approval) ❑Commercial(Approval Required)
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�ew Connection ❑Additional Connection ❑Re-Connection ❑Repairs �Disconnect
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Site Address: � �(�� �����GJOO� �-�, •
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
°Gor�tractor:Ix�for�tian:
Contractor: �" �S��K '`� S � Contact Person: � J rl�N C`c/�
Address: ��� � � '2d, l� State License#: �`� F� �
City: �10 v�ci1 Zip:S`S-��Expiration Date: �Z �'
Phone: C �� �7�' �/ S j Alternate Phone: l b �� , ���-� 7�S
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❑SAC Charge(2009 Rate=$2,000.00) $
(SAC Charge must accompany all sewer permit applicarions unless prepaid)
(Orono City Staff can determine if applicable)
(If not prepaid,a sewer connection permit wi►I not be issued)
�Sewer Conn t�on/Disconnect/Re air($50.00/Per Stub) $
Pipe size�inches;material�Schd 40 air tested; cast iron
�Water Connection/Disconnect/Repair($50.00/Per Stub) $
Pipe size_�inches;material Schd 40 air tested; copper
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1. SUBTOTAL of Permit Requested: $
2. STATE SURCHARGE $ .50
3. POSTAGE&HANDLING(Only on Mai]-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
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■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a sevarate 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.
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Applicant: � Date: � ��
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