HomeMy WebLinkAbout2008-P12086 - sewer/water connect .�� �
PERMIT
CITY OF ORONO
2750 Kelley Parkway - PO Box 66 Permit Number: p12086
Crystal Bay, Minnesota 55323 Permit Type:
Sewer and Water Pernut
(952) 249-4600 Date Issued:
5/20/2008
SITE ADDRESS: 2118 Shadywood Rd Unit#
Wayzata, MN 55391
PID: 17-117-23-42-0016
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type:
Sewer and Water Permit Permit Sub-type(s): Sewer&Water Connections
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
New water&sewer installation
FEE SUMMARY: Pernut Fee: $ 70.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: Scherber Co. LLC OWNER: Paul&Leann Hanssen
11415 Valley Dr. 2118 Shadywood Rd
Rogers,MN 55374 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
MINNESOTA BUILDING CODE REQUIREMENTS.
AP ANT PERM[TEE S[GNATURE [SSUED BY SIGNATURE
Copies: 1-File(SignaturesRequired), 1-Applicant, 1-MonthlyReports, 1-Assessing,(IfSeptic, 1-Septic) Page 1
�r,� �
FOR CITI'USE ONLY
�'��(�p'`�` City of Orono Date Received: Permit#
tlO�' `�`Q�, P.O.Box 66
�� .� . � 2750 F:elley Parkwa}� ❑In-House SAC Determination Form Completed
��� �l� �.•:�-- �� Crystal Bay,MN 55323 �
'\�'�;r,r�1���,G`� (952)249-a600 Approved By(If Required): �
� �oa..
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CITY OF ORONO—SEWER & WATER/GENERAL PERMIT
(*Note:Some pennits may�require approval by the Building Official and/or Public Works Department*)
(ALI,PERMITS- Mav bc subiect to further review and mav not be issued when the aoplication is receivcd)
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 ANS'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)
�1ew Connection � Additional Connection � Re-Connection � Repairs ❑ Disconnect
Job Site/Owner Information:
Site Address: a � (� S �.-�t� t-vr�� �c�
Owner:�fe,�,�,��., L--a�,�y,,,,.,�,,,,,,,� Mailing Address:
City: C�,a...-(.,�s �� ;-� Zip:
Home Phone: Alternate Phone: � /o� �U( bSa�
Contractor Information:
Contractor: 5�_(�.�.---(��- Cfl LL C., Contact Person: ���
Address: /�y( — �,�t I l_� �j�, State License #: � C..,1 ���y
City: �o� �-S Zip:��y Expiration Date: �� � ��
Phone: ��, "?� - ��7— / � 13 Alternate Phone: (�/ol-o��o� - -7 �'o�
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`' DETERIVIINING PERMIT FEES
� 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) $
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; 0 copper
1. SUBTOTAL of Permit Requested: $
2. STATE SURCHARGE $ .50
3. POSTAGE&HANDLING (On(y on Mail-In Applications) $ L50
4. TOTAL PERMIT FEE(Add Lines l-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
compietion 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: S o�d � U8
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