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Home My WebLink About2010-00535 - SAC credit CITY OF ORONO PERM�T�vo.: Zoiaoos3s � ` 2750 KELLEY PARKWAY ORONO, MN 55356- �ATE IssuEn: 06/29/2010 952 249-4600 FAX: 952 249-4616 ADDRESS : 2172 SHADYWOOD RD PIN : 17-117-23-42-0010 LEGAL DESC : WILEYS PARK LAKE MTKA : LOT 000 BLOCK 001 PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : RE-CONNECT NOTE: SAC CREDIT-GRANDFATHERED IN APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 AREA WIDE PLUMBING WATER CONNECT/DISCONNECT/REPAIR 50.00 9989 190TH ST. STATE SURCHARGE SEWER&WATER 0.50 SILVER LAKE, MN 55381- (952)292-5297 TOTAL 100.50 Minnesota State License#: 61937-PM OWNER DORE, STEVEN 8351 WEST 109TH STREET BLOOMINGTON, MN 55438- AGREEMENT AND SWORN STATEME1vT The work for which this permit is issued shall be performed according to the approved plans and specitications,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 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 the ate Building Code.This permit may be revoked at a�,ti#� ue cause � 2 � ��ZR �� l ^7 / �'� �� 6Y►�lC�N l l � Applicant ermitee Signature Date Issued By ignature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. � � F4R CITY USE ONLY O$��O Clty of 01'ono DateReceived: Permit# P.O.Box 66 2750 Kelley Parkway ❑In-House SAC I3etermination Form Corrg�leted ��fri,.� Crystal Bay,MN 55323 ` �_ ` '` (952)249-4600 Approwed By(If Required}: �q4�s� 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 further review and mav not be issued wheo the aoolication 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 Inf�rmation: ' Site Address: 2j�Z S��v l,voo� �� Owner: �-fic�e �oQ� Mailing Address: 2l7Z Sh�yu�000� �� City: OQ o dJ o Zip: 55��^tL_ Home Phone: Alternate Phone: ��Z- l�6 S�- l Z S� Contractor Informarion: Contractor: �2cq LcJ,d P ��wi�1'� Contact Person: Q�i4 Address: �t'jB f /l�o �'� ST State License#: �� J 3 7 � P�1 City: Sr�v�2 1a�c Zip:5�3�s Expiration Date: _1 Z-�1- 2olO Phone: QSZ-29'Z- 52 4 7 Alternate Phone: � � DETERMINING PERMIT FEES ❑SAC Charge(2010 Rate=$2,100.00) $ (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/Disconnect/Repair($50.00/Per Stub) $ Pipe size inches;material Schd 40 air tested; copper ❑Water Availability For Future Hook-Up to Water($50.00) $ Water Availabilitv 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: 1. Collect Permit Fee&Issue Water Connection Permit 1. SUBTOTAL of Permit Requested: $ 2. STATE SURCHARGE $ .50 3. POSTAGE&HANDL[NG(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 s�arate 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 Pennit, agrees to do all wark in strict accordance with the ordinances of the City and the regulations of the State of Minnesota, and certifies that a i�statements made on this application are,true and correct. / �% � /O Applicant: � Date:� "�� Reset Form