HomeMy WebLinkAbout2009-00196 (sewer & water disconnect) CITY OF ORONO PERMIT NO.: 2009-00196
� ' 2750 KELLEY PARKWAY
ORONO, MN 55356- �ATE �SSUEn: OS/OU2009
952 249-4600 FAX: 952 249-4616
ADDRESS : 3127 CASCO CIR
PIN : 20-117-23-34-0022
LEGAL DESC : COLORADO SPRINGS
: LOT 002 BLOCK 001
PERMIT TYPE : SEWER&WATER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : DISCONNECTION
NOTE: DEMOLITION OF HOUSE
APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00
CONCRETE SCIENCE SERVICES WATER CONNECT/DISCONNECT/REPAIR 50.00
7545 COMMERCE ST. WEST
HAMEL,MN 55340- STATE SURCHARGE SEWER& WATER 0.50
(763)420-4073 TOTAL 100.50
OWIVER
PETERS, FREDERICK
3127 CASCO CIR
WAYZATA, N1N 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 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 d of issuance,or if cons[ruction is
suspended for a period of l80 d s at y time after work has commenced.
The applican is responsible for su g all cequired inspections are
reque d in onforman e wit S Building Code.This permit may be
rev ed y time fo due c e
� � � / /
App ' ermitee Signature Date Issued By g ature
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO .
FOR CITY USE ONLY
� Clty of Or'on0 Date Received: Permit#
i'¢ � , P.O.Box 66
!��i. ��'' 2750 Kelley Parkway ❑In-House SAC Determination Form Completed
�� 11�'� �,�� Crystal Bay,MN 55323
�,�,r� i�i,�,i'� (952)249-4600 Approved By(If Required):
... �sxo8:..
CITY OF ORONO—SEWER & WATER/GENERAL PERMIT
(*Note:Some permits may require approval by the Building Official and/or Public Works Department*)
(ALL PERMITS- Mav be subiect to further review and mav not be issued when the aoplication 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 A 1
� Residential(May Require Approval) � Commercial(Approval Required)
❑ New Connection ❑Additional Connection ❑Re-Connection ❑ Repairs �Disconnect
Job Site/Owner Information:
Site Address: ���� ��W C� Ci��l�
Owner: �.Q�f�l�� Mailing Address:
City: O r� � Zip:
Home Phone: �S� � + `�"� � �1`�� Alternate Phone:
Contractor Information:
Contractor: C011CfZ�Q. �G�n�-�.r Contact Person: Q�. ���
`15yS ornrnel'c�.,
Address: �.� I (,l�'_ State License #:
ss34o �Z-3t - Zaoq
City: Zip: Expiration Date:
Phone: ��0.3 " �� ' �013 Alternate Phone: ��Z " ZOZ' �0�3�
DETERMINING PERMIT FEES
❑ SAC Charge(2009 Rate=$2,000.00) $
(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)
0 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) $
Pipe size�inches;material Schd 40 air tested; copper
1. SUBTOTAL of Permit Requested: $
2. STATE SURCHARGE $ .50
3. POSTAGE& HANDLING(Only on Mail-[n Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
ADDiT10NAL [NFORMATION — 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 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 ordinan�es of the City and the regulations of the State of
Minnesota, and ce�rtifies that al statement�m�e on this application are,true and correct.
,�; + ;'-
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Applicant��- ��,�� ��i � � �� Date: � V
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