HomeMy WebLinkAbout2013-00915 - sewer connect 4 ,
CITY OF ORONO * Z pJ 1 3 - 0 0 9 1 5 * �
2750 KELLEY PARKWAY DATE ISSUED: 09/06/2013
ORONO, MN 55356-
(952)249-4600 FAX: 952) 249-4616
ADDRESS : 1910 SHORELINE DR
PIN : 10-117-23-42-0017
LEGAL DESC : REG. LAND SURVEY NO. 0096
: LOT 000 BLOCK 000
PERMIT TYPE : SEWER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : CONNECTION
NOTE: SEWER CONNECTION-4"PIPE SIZE-SCHEDULE 40
APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00
WESTONKA SEWER&WATER STATE SURCHARGE SEWER&WATER 5.00
6501 CO.RD 15
MOLJND, MN 55364 MAIL-IN FEE 2.00
(952)472-4959 TOTAL 57.00
Minnesota State License#: 1804 PAID WITH CC# 7464
OWNER
&H MOUSAVINASAB,MAJID FEHRESTI
1910 SHORELINE DR
WAYZATA,MN 55391-
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 sepazate
permits. All provisions of laws and ordinances governing this type of 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 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revok t any time for due cau e.
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Applicant Permitee Signature Date Issue y Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
�Sep 03 13 01:03p Westonka Mechanical 952-472-4961 p�2 y_ __
09/03/2013 La:18 `J5'L'14yQblb ���'�-�
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/��� O�Bax OroQo D�t�&caivcd: Permit N
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+,Y�� 2750 Ke�ky Parkway ❑in-Hauac SAC Determinatlon Form Complc�d
�-,\! � , �j Cry�eaf pay,M1v Si32�
.'•ti,�,4•i�Hn��'�� (9i2)Z44-4600/Fex(952)249-4fi I6 Apytored Hy(ilRequirodJ:
CTTY OF OR4N0—SEWER &WATER/GENERAL PER�NiT
(*Note:Some pem��b mar roquiTc approval by�he Bnilding 09ieixi aadlor public Warka Departmcnt•}
(�l[.L PEHA�1'�S- IYfar he anhiett Io tae�r aeview end mey�ot be i�ned w�en the inoliention(t rettivecr
CrENERAL 1NFORMA�ON
1. Yau may appty£ar utiliry permits by mail or in person ac che Ciry of�ic.es,
2. Mailed in applieations are subject tp the postage and banQling fee shown below. Pezmi:cards w917
be sent by�etnrn mai[within 2 business days.
3. Pecmit,�arc aot vaNd antil you e-eceivc a permit asrd.
4. Work zriust not begin unless the permii card is avai�abEe on zhe job site. �
5, Utility eonre�tion pern►its rnay be issued to licensed contractors vnly.
6, Contact the Public Works i7epa�tment(953-Z49-46Q0)far ntiiiry siub a5-built locatians.
DO NOT EXCAVAT�IIY ANY S7'REET AND DO NOT tAP A�IIf MAIN without`e:press
approv�l�f the PnbFic Works Department. Issuance ofa pamit does no:�raQtthis approva3.
7. Alt work m�t be de�e�n aceordance wi[h Staee Code rzq�irements.
8. AI!wor�must be inspecced before i:is cov�red. Cail{952)2a9-4600,24+hour aotice reqsired.
TYPB OF PERNifI
Check AlI 7hat A t
�Rasidential(May Requir�c Approval) ❑Commerclal{Approval Requir��
�New Gonnection ❑Additionai Coaneeeion ❑R�Connecdoa ❑Repnirs ❑ D�sconnxt
❑ Wetcr Availabi:ity Con.cuction For Futur�Hook-Up to Water
Job Site/Ow�ner�nfomiation:
+ .
Site Address: � ��t� �lae• G1 nN !�/`. "
�
Owner: Mailing Addsess:
c��: z�p:
Hexz�.c Phone: Alternate Phone:
Contractor Information�: •
Contraceor, ��5��''k� .S c..� Contact Person: P�� � , �`' �
Address: �75�� Cr�_ ,�� � � State License�!:
City: �'�'�.o��.�z� Zip:S��'rlExpiratinn Date:
Pl�one: ��v�-t{7,1� �cl�j Aiiernate Prane: �j 1� - 7`7 f" �l � 7 �
�Sep Q� 13 01;04p Westonka Mechanical 952-472-4961 p.3
99/83/2013 10:18 4522494616 t�urvu rr.au� ut�uc
� . . .S�E�'ERNffl�1tIYG.pEfLM���E�S� ��:: .
❑SAC Cfur�e(2013�tate=SZ,435.40? a
(5AC Chazge must ac�omp$ny a�l sewer permi:apptications unlass prepaid}
(Orona City S�af;can determinc if applicabk)
(If not prepaid,a sewer ec►nneaxion permit wiII not be issaed)
LX,1 ,SBwer COa aCStio�/Di9cpRqfCt/��lir(f$Q.Op/pt�5tub) S
��� nipe size��tehes;rnatcrial�Schd 40 air tested; cast iron
❑Water Cannectioa I Disconncct/Rcpair(�Sp.Op/Pcr Stab) g
Fipe size inches;matcrial Schd 4C air tesud; eapper
❑ Water AveikabiGtr For Futare Hook-Up;o water(SSfl,pp) a
Water Availsbi�itX„Fxnlanation• �
Cantrac;or installed tine to inside of hwse for future hook-up_
This Line wil[bc inspcctcd by th� Publie Works Depertmeni.
Required$cfore Watcr G�r��cctiort PErmic is►ssued:
� 1. Usue Weter Meter&Hom Permit
z- Any Additionat Connection Fees paid(lfApp2i�eble)
� ]ssae Watcr Conncction Permit:
1. Collect Permit Fee&lssue Water Connection permit
I. SUBTOTA[,afPermit Requ¢sYed: �
2. STATE SURCHl1RGE S 5.00
J, POSTAGE&N.ANDLNG(Orly on Maik-In Applicatioas) a Z,pp
4. TOTAL pERMIT F'EE(Add Lines t-3 Abovc) g
ADDITIONAi�INFORiVIA�'i0N—WATER METERS
• WATF,R MF.TERS rnust be picked c�p a�d paid forat prono Ciry Hal1,these are on a stparat_e ncsmit,
■ WATER METkRS must be set end 9tsled by Oroao Water bepartment (952) 249-46f10� upon
camplctioa of inetcr inxtallation. .
The undersigned heteby appfies to the City vf Ororto for issuance of a Utiliry Perm'rt,agrees to do
all w3tk sn sttict accordance witl� the ardi�anees �f the City and the regulations of tt�e State of
M.innesota,and certifics thRt a11 5CiitCr.►ellts Oft�I715 S(}�1]lC3tiOfi Sl'E,tNC fll1fJ COi��I.
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Applicant: D��:�r � �+J 3