HomeMy WebLinkAbout2007-P11413 - sewer repair � PERMIT
CITY OF ORO O
Permit Number:
2750 Kelley Parkway- PO Bo 66 P11413
Crystal Bay, Minnesota 55323�� Permit Type:
Sewer and Water Permit
(952) 249-4600 Date Issued:
9/7/2007
SITE ADDRESS: 2465 Shadywood Rd Unit#
Excelsior,MN 55331
PID: 20-117-23-11-0031
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type:
Sewer and Water Permit Permit Sub-type(s): Sewer Repair
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
No Need For SAC-Sewer Repair
FEE SUMMARY: Pernut Fee: $ 35.00 Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Coppin Plumbing OWNER: lst National Bank of Navarre
8460 County Rd 15 P.O. Box 123
Minnetrista,MN Navarre,MN 55392
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 PERMITEE SIGNATURE ISSU BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, i-Assessing,(If Septic, 1-Septic) Page 1
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'`�"'� Clt Of OrOno Date Received: �� f� ermit#
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�� O� P.O.Box 66 � � ,N j�n
n;;;; 2750 Kelley Parkway In-House SAC Determinahon Form Completed `��"
� ��r�, ;. �. Crystal Bay,MN 55323
��?�,�r-�,��yE� (952)249-4600 Approved By(IfRequired):
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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 auplication 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. 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
Job SiteJ Owner Information:
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Site Address: -�.� i � _� � ��� ��� (f "� � c.�' G �i � u�
Owner:�`lC� � �'- V�. �G� � �,y' Mailing Address:
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City: Zip:
Home Phone: Alternate Phone:
Contractor Infonnation:
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Contractor: ��' 9 � � 1� Contact Person: �G�l Y1 �' �-
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Address: ���� I �%�� ���� �� � S State License #: �� �� `�` ��
City: v�1� 1l1 h � �(�` S���Zip: Expiration Date: ` � � 7 �• � �
Phone: � � � � � V � }-��--� Alternate Phone: �� �� � 7�— � �� � �%
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��a A� ���'� � � ` DETERMINING PERMIT FEES ', ����;� �' �� ' �� �
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� 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 y • Schd 40 air tested; � cast iron
❑ Water Connection/Disconnect/Repair ($35.00/Per Stub) $
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 ]-3 Above) $
ADDITIONAL INFORMATION— WATER METERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a se ap rate 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 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: � � �
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