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Home My WebLink About2014-00563 (sewer & water connection) � - CITY OF ORONO * 2 0 1 4 - P1 0 5 6 3 * 2750 KELLEY PARKWAY DATE ISSUED: 06/05/2014 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 3227 CASCO CIR PIN : 20-117-23-43-0056 LEGAL DESC : SPRING PARK : LOT MB BLOCK MB PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION NO"TE: WA"CER& SEWER CON�IEC"I�ION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 WATER CONNECT/DISCONNECT/REPAIR 50.00 BOLLIG& SONS, INC. STATE SURCHARGE SEWER& WATER 5.00 11401 COUNTY ROAD 3 HOPKINS,MN TOTAL 105.00 (6l2)938-4433 Payment(s) CREDIT CARD 6881 105.00 OWNER O'ROURKE, JAMES 1181 VAGABOND CT N PLYMOUTH, MN 55447- 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 aRer 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. � c� S I �� '� � W �� , ,� App icant Permitee Signature Date Issu By Signature Date FOR CITY USE ONLY / ��^/O City of Orono Date Received: Permit# P.O.Box 66 ! - ' 2750 Kelley Pukway ❑In-House SAC Determination Form Completed Crystal Bay,MN 55323 ',i r�,�� (952)249-4600/Fa�c(952)249-4616 Approved By(If Required): A��iM 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 anplicadon is receivedl GENERAL INFORMATION 1. You may apply far 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. Pernut 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 pernuts 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 reqnired. TYPE OF PERMIT Check All That A 1 �CYltesidential(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: SiteAddress: �`'',�� a��-� �� '` Owner: ��ne VV��LJ LLC Mailing Address: �S 3 l�.Q,�'�' ��C S�" c�Ty: IQ� ��7�i�}v� z�p: SS.��1 � HomePhone: �7�� AlternatePhone: �� Contractor Information: Contractor: �� 5 Contact Person: � ��V �� Address: �� `� � State License#: � �� City: 1 �1�15 Zip:��Expiration Date: � � �� Phone: �Sa�-�� ')�� Alternate Phone: ��' �� I � �J�d DETERMINING PERMIT FEES ❑SAC Charge(2014 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 �'ater 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 Explanation: Contractor installed line to inside of house for future hook-up. This line will be inspected by the Public Works Department. RecLuired 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. Coilect Permit Fee&Issue Water Connection Permit 1. SUBTOTAL of Permit Requested: $ 2. STATE SURCHARGE $ 5.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 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 sepazate 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 ardinances of the City and the regulations of the State of Minnesota,and certifies that all statements made on this application are,true and conect. i � � s � �� Applicant: Date: