HomeMy WebLinkAbout2016-01511 - repair sewer *` ° �� CITY OF ORONO
2750 KELLEY PARKWAY * � 0 1 6 - 0 1 5 1 1 *
DATE ISSUED: 12/02/2016
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2725 SHADYWOOD RD
PIN : 21-117-23-24-0004
LEGAL DESC : PHEASANT LAWN
: LOT 026 BLOCK 000
PERMIT TYPE : SEWER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : REPAIR
NOTE: CURE IN PLACE LINER
APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00
STATE SURCHARGE SEWER&WATER 1.00
BENJAMIN FRANKLIN PLUMBING
5718 INTERNATIONAL PKWY TOTAL 51.00
NEW HOPE, MN 55428- Payment(s)
(612)238-9709 CREDIT CARD 8156 51.00
Minnesota State License#: plbg-PC643703,mech-MB004722
OWNER
MEEK, MICHEAL&ROBERT
2725 SHADYWOOD RD
EXCELSIOR,MN 55331-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,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 goveming this type oY 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 I 80 days at any time afrer work has commenced.
rhe applicant is responsible for assuring all required inspections are
requested in conformance with the Sta[e Building Code.This permit may be
revoked at any time for due cause.
_ _�_ �( l�, �, /,�o
Applicant rtee Signature Date Issued By gnature Date
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��- t�o c�T�' ��oivc,� � 15`�
� �O�� Clty Of Oi'ORO Date Received���—!�ermit# d��'-
� ; P.O.Box 66
i ; 2750 Kelley Parkway ❑In-House SAC Determination Form Completed
���, 1� ,�f Crystal Bay,MN 55323
\\A�SHo4��� (952)249-46()0/Fax(952)249-4616 Approved By(I�'Requ'vedj:
CITY OF ORONO—SEWER& WATER/GENERAL PERMIT
(*Note:Some pemiits may require approval by the Building Official and/or Public Works Department')
(AI.L PERMTI'S- Mav be subiect to further review aod mav not be issued wLen the ao�lica8on is receivedl
GENERAL INFORAqATIOI�
1. You may apply for urility permits by maii 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 rehun 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. Urility connecrion 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 Worizs 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 PER1viIT
Check All That A i
�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 In#'o�ation:
�— � �e1
Site Address: �� 7�� ����r�� l.�'v�
Owner: �?>� �t 1���/� Mailing Address: S��-�
City: �X C�;�S��' Zip: �S�S 3 j�
Home Phone: �j� ��7'��Ua Altemate Phone:
Contractor Information:
Contractor: ��'���.�,lr��nK�h i'��`��C"ontact Person: �I/ p�G� ��r�,��
1 n�.rvt��lM at / ,t�a ilC- �
Address: �7 15.3 `' � State License#: �� �`� 7d>
City: /V(Y✓ � Zip:SS`/,�� Expiration Date: ( a-`3 �'-�-6
Phone: �/ ��� 3���U� Alternate Phone: 7( 3"�`�S����G�
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�7ETFs��+�T�O'P�?'FE� _
❑ SAC Charge(2015 Rate=$2,485.00) $
(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 Stuti) $
Pipe size�inches;material Schd 40 air tested; cast iron �L�„c ,�p1`� l.�r
❑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) $
Wster Availsbilitv Ezulanation:
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 Peruiit Fee&Issue Water Connection Permit
1. SUBTOTAL of Permit Requested: a
2. STATE SURCHARGE $ 1.00
3. POSTAGE&HANDLING(Only on Mail-In Applications) S 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
ADDITIONAL INFORMATT03�1—V�ATER 1�1ETERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a seuarate permit.
■ WATER MET'ERS 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: ( �^�'�( b