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Home My WebLink About2013-01160 (sewer & water reconnect) � CITY OF ORONO * z 0 1 3 — 0 1 1 6 0 * . 2750 KELLEY PARKWAY pATE 1SSUEn: 10/30/2013 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 VERMIT 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 I-3ASTINGS, MN 55033- STATE SURCHARGE SEWER& WATER 5.00 (65l)480-U55 TOTAL 105.00 PAID WITH CC# 0444 OWNER O'ROURKE,JAMES 1 181 VAGABOND CT N PLYMOUTH, MN 55447- AGREEMENT AND SWORN STATEMENT l�he work fi�r which U�is permit is issued shall be performed according to the approved plans and specitications,applicable City approvals,and the S[ate Building Code. "l his permit is Yor 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 me fo e ause. /'� � �3a � /3 , Ap icant Permitee Sigdature Date Issued By S' ature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBE ABOV ,...,�.�.,..�._,... ,. .,. _ . . ,�.,,�....,,,.. : �.,.�- ? .�__,_,.�.., � __�..-..� __..,.�.�,� �"'"T." ,�.>" , ' FOR CITY USE ONLY ��^/� City of Orono Date Received: Yermit# P O. Box 66 �1 2750 Kelley Parkway ❑In-House SAC Determination Form Completed >, > , ; Crystal Bay,MN 55323 � � "�,�.�,E��` (952)249-4600/Fax(952)249-4616 Approved By(If Required): htSHl�. . CITY OF ORONO — SEWER & WATER/ GENERAL PERMIT (*rote:Some permits may require approval by the Buildin;Official and/or Public Works Department*) (.4LL PERM[TS- Nlav be subiect to further review and mav not be issued when the analication 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 on(y. 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) �New Connection ❑ Additional Connection �Re-Connection ❑ Repairs ❑ Disconnect N ❑ Water Availability Conn c ton For Future Hook-Up to Water Job Site/Owner Information: Site Address: _.3�a 7 �fI�S�'D ��'��- Owner:�N��/� �L�/�S , Mailing Address: City: Zip: Home Phone: Alternate Phone: Contractor Information: Contractor: �,.5,/� �i,�L►q��✓� Contact Person: lOD��'�� Address: �9/� ��ti�'�P�/5�/�State License #: City: �75NGi5 Zip: �33 Expiration Date: Phone: �S'I-yf�0 -�35�� Alternate Phone: �/� 9�S Y3�1� . 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) ❑ er Connecti isconnect/�pair($50.00/Per Stub) $ Pipe size inches; material /i�/�LBchd 40 air tested; cast iron ❑ Water 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. 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: l. Collect 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 I-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 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: /��3��/,3