HomeMy WebLinkAbout2006 - P09997 - sewer/water disconnect PERMIT
CIT1' OF ORONO
�750 Kelley Parkway- PO Box 66 Permit Number: P09997
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Pernut
(952) 249-4600 Date Issued:
6/16/2006
SITE ADDRESS: 2695 Casco Pt Rd Unit#
Wayzata,MN 55391
P��� 20-117-23-23-0003
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type:
Sewer and Water Permit Permit Sub-type(s): Sewer&Water Disconnectic
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
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FEE SUMMARY: Permit Fee: $ 70.00 va►uation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: Highview Plumbing Inc. OWNER: David Peck&Diane Rankin
4301 Highview Pl 2695 Casco Point Rd
Minnetonka,MN 55345 Wayzata,MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO Df�ALL WORK IN STR�CT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA B I;�NG CODE REQUI EMENTS.
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PPL ANT E M G URE ISSUED BY SIGNATURG
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Copies: 1-File(Signatures Reguired), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
FOR CPTY USE ONLY
//04��0 City of Orono Date Received: Permit#
P.O.Box 66
2750 Kelley Parl:way ❑In-House SAC Determination Form Completed
� n��'�' ��' Crystal Bay,MN 55323
' `a (952)249-4600 Approved By(If Required):
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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 Departrnent*)
(ALL PERMITS- Mav be subiect to further review and mav not be issued w6en the aovlication 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. Utiliry 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)249-4600,2A+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 �isconnect
Job Site/Owner Information:
Site Address: ��L�ca � ��� ,
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'�-� ��,��'�Owner: ���t/�,�P�G1� `, �GIL�'Y�{� Mailing Address: I ��� ��'� �`�S�
� City: � � �- C � � S���
Zip:
Home Phone: Alternate Phone:
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Contractor Information:
Contractor: ���U�C�� /l�i�,�//1� ,�x'Contact Person: �C7`'�Q��/�
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Address: `t��'� � /!��/'!�� State License#: '��3 r�
City: ��� J� Zip:��5 Expiration Date: �� 3I d �'
Phone: '�✓�J �U Alternate Phone: (�`� ���� �y��
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DETER.MINING PERMIT FEES
_ SAC Charge(2005 Rate=$1,550.00) $
(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 pisc� onnect/ pair($35.00/Per Stub) S
Pipe size mches, Schd 40 air tested; cast iron
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Water Connectio /Disconnect/R pair($35.00/Per Stub) $
Pipe size inc es;materia Schd 40 air tested; copper
1. SUBTOTAL of Permit Requested: $
2. STATE SURCHARGE $ .50
3. POSTAGE&HANDLING(Only on Maii-In Applications) $ 1.50
4. TOTAL PERMTT 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 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 wark 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: ���/�a..e��rl��l'`�c�--� Date: �G D (�
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