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HomeMy WebLinkAbout2013-01220 (sewer-reconnect) CITY OF ORONO * 2 0 1 3 - 0 1 2 z 0 * � 2750 KELLEY PARKWAY DATE ISSUED: 1U14/2013 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 3227 CASCO CIR PIN : 20-117-23-43-9999 LEGAL DESC : SPRING PARK : LOT MB BLOCK MB PERMIT TYPE : SEWER& WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : RE-CONNECT APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 D.S.M. EXCAVATING WATER CONNECT/DISCONNECT/REPAIR 50.00 2916 ENTERPRISE AVE HASTINGS, MN 55033- STATE SURCHARGE SEWER&WATER 5.00 (651)480-1355 TOTAL 105.00 PAID WITH CC# 0444 OWNER O'ROURKE, JAMES l 181 VAGABOND CT N PLYMOUTH, MN 55447- AGREEMENT AND SWORN STATEMENT I�he work for which this pemiil is issucd shall bc performcd according to the approved plans and speciYications,applicable City approvals,and the State Building Code. This permit is 1br only the work described and does not grant permission for additional or related work which requires separatc permits. nll provisions of laws and ordinances governing this type of work shall be compied with whether or��ot 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 reyuired inspections are requested in confonnance with the State Building Code.This pemlit may be revoked at any time for due use. � � � � /<�� ly � /3 � � Applicant Pcimi e Signature Date Issued By � nature ate SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB . FOR CITY USE ONLY �����/� City of Or'ono Date Received: Permit# P.O. Box 66 /�� 2750 Kelley Parkway ❑ [n-House SAC Deterniination Form Completed �� i , ; Crystal Bay,MN 55323 .�k� ����� (952)249-4600/Fax(9�2)2a9-4616 Approved By(If Required): tii�� CITY OF ORONO —SEWER & WATER/ GENERAL PERMIT (*Note:Some permi[s may require approval by the Building Ofticial and/or Public Works Department*) (ALL PERM17'S- �tav be subiect to further review and maV not be issued when the ann��cation is received) GENERAL INFORMATION 1. You may apply for utility pennits 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(9�2-249-4600) 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 ❑ Water Availability Conn c ion For Future Hook-Up to Water Job Site / Owner Information: Site Address: 'J���� ���C'� ���'C',�G� Owner: �f�"JG�� ��'�'Q"5' Mailing Address: City: Zip: Home Phone: Alternate Phone: Contractor Information: � ` � � ,�/� ��'►K' � � ,C'�- C���'�`�/�''��� Contractor: �,��� L%��`�� Contact Person: � Address: G'�/L ����'%��= � State License #: City: ���C�� Zip: �v���Expiration Date: /,� ��� ` � � � � � Phone: ��� 7��"���� Alternate Phone: (� Z ��� ��`� DETERMINING PERMIT FEES ❑ SAC Charge(2013 Rate=$2,435.00) $ (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/ air($50.00/Per Stub) $ Pipe size__� inches; material ���•Schd 40 air tested; cast iron ❑ Water Connection/Disconnect/Repair($50.00/Per Stub) $ Pipe size f 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. Required Before Water Connection Permit is Issued: 1. Issue Water Meter&Hom Permit 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Connection Permit: 1. Coliect 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 separate permit. • WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon completion of ineter installation. The wldersigned 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 tllis application are,true and correct. 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