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Home My WebLink About2017-00608 - water repair � � CITY OF ORONO * z 0 1 7 — 0 0 6 ra 8 * ' 2750 KELLEY PARKWAY DATE ISSUED: 06/OS/2017 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 3340 SHORELINE DR PIIV : 17-117-23-44-0085 LEGAL DESC : REG. LAND SURVEY NO. 1433 : LOT 000 BLOCK 000 PERMIT TYPE : WATER PROPERTY TYPE : COMMERCIAL-BUSINESS CONSTRUCTION TYPE : REPAIR NO'I'E: WATER REPAIR-PIPE S[ZE 2"-COPPER APPLICANT WATERCONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER&WATER 1.00 INTERSTATE REMOVAL LLC MAIL-IN FEE 2.00 20920 FOREST RD N P O BOX 1028 TOTAL 53.00 FOREST LAKE,MN 55025- Payment(s) (651)248-7445 CHECK 222523 53.00 Minnesota State License#: SW-PM064972 OWNER Holiday Companies GLEASON,NICK PO BOX 1224 MINNEAPOLIS, MN 55440- � AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable Ciry 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 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 revoked at any time for due cause. ( � -ellb'U (�i' lJr' il� Appiicant Permitee Signature Date Issu d B Signature Date ' RECEIVED _ _ JUN 0 5 2017 I�'OR CI"1'Y USE ONLY ._ o _, � �! �' City of Orono Date Received: Permit# � ''.o.�°"6� CITY OF ORON � 2750 Kelley Parkway In-House SAC DeterminationFonn Completed �, � � Crystal Bay,MN 55323 �'��,r�� (952)249-4600/Pax(952)249-4616 Approved By Qf Required): . hrsiiu CITY OF ORONO-SEWER& WATER/GENERAL PERMIT (*Note:Some pennits may requirc approval by lhe I3uilding Official and/or Public Works Department*) (ALI.PERMITS- Mav be subiect to further review and mav not be issucd when the apnlication is received) GENERAL INFORMATION 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 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 rec�uirements. 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 ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address: �.3 �{D _S�rt (�wc 'Jfr(i( d(iA✓'rt , �r� -S.S3 Y/-�i�oG Owner: �-1vY�n OS��iva✓� MailingAddress: ��o �,�,rc��e �r�ve City: {�avarr� Zip: SS39/ - �� ---. Home Phone: G 1,?-36�— �/63 Alternate Phone: Contractor Information: Contractor: ln�rrs�,,�t �..-,a,4� L L C- Contact Person: �+�''� �a�r}Sr,r� Address: �C�� 3ox /0�8 State License #: �m d��9 7� City: �i�rs��e,�� Zip:S�S Expiration Date: ��31�/S� Phone: G��/' o?yk� 7�l�S Alternate Phone: �'S/- 7`s- o7Gs t � ❑SAC Charge(2016 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 Stub) $ Pipe size inches;material Schd 40 air tested; cast iron [�]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) $ Water Availabilitv Exulanation: 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 Permit Fee&Issue Water Connection Permit oa 1. SUBTOTAL of Permit Requested: $ ,�v I 2. STAT'E SURCHARGE $ 1.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ S3 � ADDITIONAL INFORMATI�N—WATER METERS ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a senarate 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 aze,true and correct. Applicant: � Date: s�3d�7