HomeMy WebLinkAbout2008-P11946 - sewer/water permit . �
PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: p11946
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued:
3/31/2008
SITE ADDRESS: 2264 Shadywood Rd Unit#
Wayzata,MN 55391
P��� 17-117-23-43-0124
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: Sewer and Water Pernut Permit Sub-type(s): Sewer&Water Connecrions
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 70.00 Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: P&D Plumbing OWNER: Thomas Ziegler
25638 Iris Ave 2264 Shadywood Rd
Chisago City,MN 55013 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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APPLICAN ERMITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(SignaturesRequired), 1-Applicant, 1-MonthlyReports, 1-Assessing,(IfSeptic, 1-Septic) Page 1
'FOR CITY USE ONLY
O,¢d�O City of Ol'ono DateReceived; Permit#
P.O.Box 66
` 2750 Kelley Pazkway ❑In-House SAC Determination'Form Completed
.rj, �;',.� Crystal Bay,MN 55323
?��� (952)249-4600 Approved By(If Required);
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 when the aoalication is received)
GENERAL INFORMAT�ON
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 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. 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. Cali(952)249-4600,24+hour notice required.
TYPE OF PERIVIIT
�� � � �� �� Ch�ck At1.That A . 1 �`�� � �
�'Kesidential(May Require Approval) ❑ Commercial(Approvai Required)
�New Connection ❑Additional Connection �Re-Connection Q]�Repairs ❑Disconnect
Job Site/-Owner Tnformation: '
Site Address: �
Own� Mailing Address:
City: Zip;
Home Phone: Altern�one: �/��,�4������/
Contractor Info"rmation:
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Contractor: �n_ y�.� Contact Person:
Address: ?���� ,/'J ,G� State License#: ��
City: C�,�� � Zip:�v��Expiration Date: �� ,�f � `
Phone: ��o?dJ ��v� Alternate Phone:
� 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) $ � S � ��
Pipe size inches;material Schd 40 air tested; 0 cast iron
❑Water Connection/Disconnect/Repair($35.00/Per Stub $ � S• �
Pipe size inches;material Schd 40 air tested; � copper
1. SUBTOTAL of Permit Requested: $
2. STATE SURCHARGE $ .50
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ��• ��
ADDITIONAL INFORNIATION—WATER NIE3'ERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate vermit.
■ 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.
Applicant: Date: � � D�
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