HomeMy WebLinkAbout2007-P11102 - sewer/water permit - - PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: p11102
Crystal Bay, Ulinnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued:
6/11/2007
SITE ADDRESS: 2216 Shadywood Rd Unit#
Wayzata,MN 55391
PID: 17-117-23-42-0004
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:
SAC-GI#1441 4/24/67
FEE SUMMARY: Permit Fee: $ 70.00 va�uation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: Westonka Sewer&Water OWNER: John 1 Henry III
6501 Co. Rd 15 2216 Shadywood Rd
Mound,MN 55364 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.
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APPLICANT ITEE S[GNATURE ISSUED BY SIGNATU E
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
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TOR CITY USL ONLY �� _�`�
� —� Ctty OT Ot'On0 Date Received: Permit 11 "�''
'� � �\�� P.O.Box 66
j �,,. �\; 27j0 Kelley Park��ay ❑In-House SAC DMermination Porm Completed ,�'L�� �Zr}��j7
y �i�'�� - �� Cryst�l Bay,MN�5323
'�'�d+��,� �}>au`f O��)249-4600 Approced I3y(If Required): �
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CITY OF ORONO—SCWE12 & WATE12/G�NEI2AL YERMIT
(*Notc:Somc permits may require approv�l by the Buildin�OfPicill and/or Public Works Department*)
(,�LI,PER`iITS- i�'lav be sublect to furlher re�•iew�nd m;rv not bc issuccl�nc�n the application is reccived)
GCN�RAL INFORMA'l ION
1. You may apply for utility permits by mail or in person at the City offices.
2. Mailed in applications are subjcct to the postage and handlin� fee shown belo���. Permit cards wil(
be sent by return mail within 2 busincss days.
3. Pern�its nre not valid until you receive a permit c�rd.
�4. Worl:must not be�ii� unless the permit card is available on the job site.
�. Utility connection permits may be issued to licensed contractors only.
6. Contact the Public Works Dcpartment(952-2�19-4600)for utility stub as-built locations.
DO NOT E\CAVA1'E IN AN�'STRLET AND UO N01'TAP ANl' �'Ir1IN without express
npprov�l of the Public�Vorlcs Department, Issuance of a per�nit does not grant this approval.
7. All work must be done in accordance with State Code requiremencs.
8. Ail worl: must�be inspected before it is covered. Call(952)?�9-4600,�4+ho«r notice required.
TYPC OF PERMIT
(Checic All That Apply)
�Residential(May Require ApprovaO � Conunercial(Approval Re�uired)
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�Ne�v Connection � Additional Connection�Re-Connection �� Repairs � Disconnect
Job Site / Owner Informatioil:
SiteAddress: �� � � W��V
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1����ner: d ��� �1r'�� �Vlaiiina Adclress:
City: lip:
Home Phone: Alternate Phone:
� Contractor Inforn�ation: �,�.��
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Contractor: � [ � �{ ��� Contact Person: .�W 1 AN l� l� � �I �� � �
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nddress: �`�.J�� �� �� � State Lice�lse #:
City: ���vV�� V ��' 7ip:���1 Expiration Date:
Phone: ��� v(��' -1 ��11/ Alternate Phone:
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DETERMINING PERMIT FEES
� SAC Chargc(2007 Rate=�1,675.00) � �
(SAC Charge must accompany a}l se�ver permit app(ications unless prepaid)
(Orouo City Staff can determine if applicable)
(If not prepaid,� sewer connection permit will not be issuect)
O� Sewer Con t on/Disconnect/12epair 35.00/Per Stub) $
Pipe size�inches; material_ Schd air tested; �_cast iron
� �i��ter Coni c�tion/Disconnect!Repair(�35.00/Per Stub) �
Pipe size � _inches; material Schd 40 air tested; � copper
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1. SUI3TOTAL of Perii�it Requested: $
?. STA"I'E SURCHARGE $ .50
3. POS"CAGE& 'rlr�ivDLING (Onfy on Ylail-In Appiications) S 1.50
=0. TO'I'AL P�l21IlT �'E� (Add Lines 1-, r�bove) $
ADD[TIONAL INFORMATION - WATER METERS
■ �1'A'fER l�'IGTERS must be pickcd up and paid for at Orono City Hall,these are on a seqarate pennit.
a Wf�'T�:I2 I�1GTGl2S must be set and sealec� by Orono Water Dep�►•tment (9�21 2-t9-�1G00, upon
completiun of mctcr installation.
The undersigned hcreby applies to the City of Orono for issuance of a Utility Permit, agrees to do
all w�ork in strict accordance with the ordinances of the City and the regulations of the State of
Minnesota, and certifies that all s teme made on this application are, tcue and correct.
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Applicant: ��'"- - Date:
Reset Form
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FOR ITY USE OIVLY
0 ,�` City of Orono ��� I�;1
O4 `YO P.O.Box 66 Date Received: 1� Permit#
�,,t,V,,, 2750 Kellcy Parkway
��� J;.: A i oved B if Re uired
� ��j�_-,-�; � Crystal Bay,MN 55323 PP' Y�� 9 )�
����i�..o` (952)249-4600
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CITY OF ORONO -WATER METER FORM
(*note:Some permits may require approval Uy the Building OC6cial and/or Public Works Department*)
GENERAL INFORMATION
1. WATER METERS must be picked up and paid for at City Hall.
2. If Uossible, fax in this application ahead of time; we will then call you and let you know we have
the water meter in stock. Fax Number: (952)249-4616. Also,you can call ahead of time to make
sure we received the fax,or to wai7i us that the fax is conung.
3. WATER NIETERS must be set and sealed by Orono �Vater Department (952) 249-4600,
upon completion of ineter installation.
TYPE OF PERMIT
(Check All That Apply)
%�Residential(May Require Approval) ❑ Commercial(Approval Required)
�New Meter ❑ Additional Meter—For: _ ❑ Replacement Meter
Job Site/ Owner Information: �-
2 [ �
Site Address: 2 � � �-��-`
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Inforrnation:
Contractor: �_�i,��-�� � �- Contact Person: ��� � �'�� �
Address: �3500 �I w�c�e�� State License #:
City: ���<<S Zip: Expiration Date:
P11one: �S t- �`l�]-u�"�1�� AlternatePhone: (,.S �- ?�� -���t��
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2007 -WATER METER PERMIT FEES
❑ 5/8"METER-$240.00 ❑ 3/4"METER-$291.00 METER-$356.00
❑ 5/8"HORN -$ 44.62 ❑ 3/4"HORN -$ 49.03 "HORN - $ 73.12
� "WATER METER (THESE WILL HAVE TO BE SPECIAL ORDERED&PRICES DETERiVIINED)
1. METER FEE: $ ��`�
2. HORN FEE $
-7�� (�
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) $ �� � ��
CITY-USE ONLY
B�,N�: N , ��k��
SIZE: ❑ 5/8" ❑ 3/4" (�1" ❑ Other "
SERIAL#: -�I 1 ���� �J<-�I
III III IIII I II II IIIIII I III I Ili
ERT HIGH#: 1810051770 (if applicable)
ADDITIONAL INFORMATION—WATER METERS
The undersigned hereby applies to the Ci'ry of Orono foi� issuance of a water meter permit, agrees
i0 Ci0 aii WOii:lri S�I1Ct aCCOr�u::Ce SVltr��:� O .»T:CeS Of tl':e �':ly an�the reg�ilations of the State
of Minneso and certifies that all statem t�`made on this application are, true and correct.
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Applicant: Date:
Origirial: 1-Address File
�fakc� Copies For: 1- Utilit}�Bzlling De��artme��t 1- Caslr Drawer