HomeMy WebLinkAbout2005-P09049 - water connect �
` � PERMIT
CITY OF ORONO Permit Number:
2750 Kelley Parkway- PO Box 66 P09049
Crystal Bay, vlinnesota 55323 Permit Type:
Sewer and Water Permit
(952) 249-4600 Date Issued:
8/8/2005
SITE ADDRESS: 2377 Shadywood Rd Unit#
Wayzata,MN 55391
P��� 17-117-23-44-0009
DESCRIPTION:
Proposed Use: Commercial-Business
Permit Class: General
Permit Type:
Sewer and Water Pernut Permit Sub-type(s): Water Connection
DETAI LS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Pernut Fee: $ 35.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Pete's Water&Sewer,Inc. OWNER: Caribou Coffee
800 Lowry Avenue NE 3900 Lake Breeze Ave
Minneapolis,MN 55418 Brooklyn Ctr,MN 55429
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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APpT,IC PBRMITEE SIGN URE �
ISSUED BY SIGNATURE
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Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
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FOR CITYsjSE ONLY
,�0� City of Orono Date Received: — �` Permit# 0``JO y��
P.O.Box 66
��P � 2750 Kelley Parkway ❑In-House SAC Determination Fo Completed '
��'���`r � Crystal Bay,MN SS323
�� �T ���o` (952)249-4600 Approved By(If Required):
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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 annlication is received)
GENERAL INFORMATION
1. You may apply for utility permits by mail ar in person at the City offices.
2. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards will
be sent by return mail within 2 business days.
3. Permits are not valid until you receive a pernut card.
4. Work must not begin unless the peinut card is available on the job site.
5. Utility connection pernuts 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 Apply)
❑Residential(May Require Approval) �Commercial(Approval Required)
❑ New Connection ❑Additional Connection ❑Re-Connection ❑ Repairs ❑ Disconnect
Job Site/ Owner Information: '
Site Addre • `�Cit �//
ss. �
Owner: Mailing Address:
City: Zip:
Home Phone: Altenzate Phone:
Contractor Information:
Contractor: ��S tn�� d���-.��ontact Person: _ �--_�''��
Address: � i t,✓� � N�State License #: C�O v �.�� Q�/�I
City: /� � Zip� /��ExpirationDate: �� — � 1 � �-�
Phone: �j� - ���`''�/6� Alternate Phone:
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DETERMINING PERMIT FEES
❑ SAC Charge(2005 Rate=$1,450.00) $
(SAC Charge must accompany all sewer pernut applications unless prepaid)
(Orono City Staff can deternune 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 Connectio Disconnect/Repair($35.00/Per Stub) $
ip �`- 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 1NFORMATION—WATER METERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a senarate pemut.
■ 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 stateme ts made on this application are, true and correct.
Applicant: Date: � ^ � ^��
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