HomeMy WebLinkAbout2005-P09151 - sewer/water connect PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: P09151
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952)249-4600 Date Issued:
9/8/2005
SITE ADDRESS: 3655 Togo Rd Unit#
Wayzata,MN 55391
PID: 17-117-23-31-0036
DESCRIPTION:
Proposed Use: Religious
Permit Class: General
Permit Type:
Sewer and Water Permit Permit Sub-type(s): Sewer&Water Connections
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 70.00 Valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: Widmer Construction LLC OWNER: Navarre Congregation of Jehovah Witnesses Inc.
9455 County Rd. 15 1717 Avocet Lane
Maple Plain,MN 55359 Mound,MN 55364
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.
40"APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
FOR CITY USE ONLY
�0 City of Orono Date Received: Permit#
0" O P.O.Box 66
2750 Kelley Parkway E]In-House SAC Determination Form Completed
Crystal Bay,MN 55323
s � $a (952)249-4600 Approved By(If Required):
CITY OF ORONO–SEWER& WATER I GENERAL PERMIT
(*Note:Some permits may require approval by the Building Official and/or Public Works Department*)
(ALL PERMITS- May be subject to further review and may not be issued when the application is received)
GENERAL INFORMATION
1. You may apply for utility permits by mail or in person at the City offices.
2. Mailed in applications are subject to the postage and handling fee shown below. Permit cards will
be sent by return mail within 2 business days.
3. Permits are not valid until you receive a permit card.
4. Work must not begin unless the permit card is available on the job site.
5. Utility connection permits may be issued to licensed contractors only.
6. Contact the Public Works Department(952-249-4600)for utility stub as-built locations.
DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express
approval of the Public Works Department. Issuance of a permit does not grant this approval.
7. All work must be done in accordance with State Code requirements.
8. All work must be inspected before it is covered. Call(952)249-4600,24+hour notice required.
TYPE OF PERMIT
(Check All That Apply)
❑Residential(May Require Approval) ❑ Commercial(Approval Required)
New Connection ❑Additional Connection Re-Connection ❑ Repairs ❑Disconnect
Job Site/ Owner Information:
Site Address:
Owner: N,4,44,90f- Mailing Address:
City: 012d-10 Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor: 6CJ<CliN e— CcW$:'.wcT--'Contact Person: E–
Address: Sys S �=✓� �C �S State License#:
City: /�/���f ' Zip:SExpiration Date:
Phone: ��y-sr =5�6 Alternate Phone:
DETERMINING PERMIT FEES
❑ SAC Charge(2005 Rate=$1,450.00) $
(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)
9�.Sewer Conn tion/Disconnect/Repair($35.00/Per Stub) $
Pipe size inches;material K Schd 40 air tested; cast iron
❑ Water Connection/Disconnect/Repair($35.00/Per Stub) $
Pipe size y inches;material Schd 40 air tested; copper
CJp141.
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 INFORMATION-WATER METERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate permit.--_
■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon
completion of meter 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.
Applicant: Date: ��