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Home My WebLink About2011 - 00162 - water connect CITY OF ORONO PERMIT NO.: 2011-00162 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUED: 03/17/2011 • (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2605 WEST LAFAYETTE RD PIN : 21-117-23-21-0007 LEGAL DESC : SHORE HILLS : LOT 000 BLOCK 000 PERMIT TYPE : WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION NOTE: WATER CONNECTION APPLICANT WATER CONNECT/DISCONNECT/REPAIR 50.00 WESTONKA SEWER& WATER STATE SURCHARGE SEWER&WATER 5.00 6501 CO.RD 15 MOUND,MN 55364 TOTAL 55.00 (952)472-4959 Minnesota State License#: 1804 , / /,04COWNER ,C?G? BLANKENSHIP,BRADFORD&DEBORAH 2605 WEST LAFAYETTE RD 7/. a Sao . 0 O 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 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 revoked at any t.• •r due cause. -'� //7/ 7 / plicant •ermitee Sig :I re Date Issue.<:y Signature Date / /SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBE dIABOVE. i _. N. FICIT USE ONLY 0,0 A,. City of Orono Date Received: / ff Permit# ii-1.A./�"� P.O.Box 66 2750 Kelley Parkway 0 In-House SAC Determination Form Completed ijyr Crystal Bay,MN 55323 fiiµti (952)249-4600 Approved By(If Required): �t+tseso$ CITY OF ORONO—SEWER& WATER/ 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) Tew Connection ❑Additional Connection ❑Re-Connection 17]Repairs ❑ Disconnect r ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address: o \OL L- 0wneA / ( 8(a, .V 1p ailing Address: 6 1-5 . LL(I yd/i ,v(___ City: b (o Yt v Zip: 55 331 Home Phone: Alternate Phone: Contractor Information: Contractor: as/-1-6-44A Contact Person: &1/L CUV1 Address: State License#: City: Zip: Expiration Date: Phone: Alternate Phone: ,J.- , ' r.. ; ;- DE` ER INM, PEI rFEES t 4 . '::',1,';,t75 .;t ❑ SAC Charge(2011 Rate=$2,230.00) $ (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 ater Connection/Disconnect/Repair($50.00/Per Stub) 7ESV $ t}'O ; Pipe size inches;material Schd 40 air tested; copper Water Availability For Future Hook-Up to Water($50.00) $ Water Availability Explanation: 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 1. SUBTOTAL of Permit Requested: $ .50 . 60 2. STATE SURCHARGE $ 5jj,fr6 O6 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2 0 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ -5— 66 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: