The URL can be used to link to this page

Home My WebLink About2011-01312 - sewer/water connect � , CITY OF ORONO PERMIT NO.: 2oii-o�3�2 2750 KELLEY PARKWAY ORONO, MN 55356- DATE ISSUED: 10/24/2011 952 249-4600 FAX: 952 249-4616 ADDRESS : 3095 CASCO POINT RD PIN : 20-117-23-34-0005 LEGAL DESC : REG. LAND SURVEY NO. 131] : LOT 000 BLOCK 000 PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 FINAL GRADE, INC WATER CONNECT/DISCONNECT/REPAIR 50.00 3441 BLUFF DR. JORDAN, MN 55352 STATE SURCHARGE SEWER& WATER 5.00 (952)492-5100 S.A.C. 0.00 Minnesota State License#: 1442 MAIL-IN FEE 2.00 TOTAL 107.00 OWNER WHIPPLE, PHILLIP 3095 CASCO PT RD WAYZATA, MN 55391- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to [he approved plans and specitications,applicable City approvals,and the S[ate Building Codc. 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 permi[may be revoked a[any time for due cause �_�� - / / / / Applicant Permitee Signature Date Issued By nature ate SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED AB . FOR CITY USE ONLY ��0�� City orUl'On0 Date Rcceived: Permit# Q �� P.O.Box 6fi ,•: 2750 Kelley Parkway ❑In-House SAC Determination Fonn Completed t+;'. � �� Crystal Qay,MN 55323 �� -�r }�o,-.�� (952)249-4600 Approved E3y(If Required): �xaaso°.- CITY OF ORONO—SEWER & WATER/ CENERAL PERMIT (*Note:Some permits may rcquire approval by thc 13uilding Ofticial and/or Public Works Department*) (ALL PER�11"f S- �la��be subiect to fw-iher revie�r and ma��not be issued�rhen the application is receivecl) GENERAL INFORMATION 1. You may apply fu;-utility pern�it5 by mail or in person ut the City oftices. 2. Mailcd in ap��lications are subject to thc posta�e and handling fee shown below. Permit cards will be sent by returi� mail within 2 business days. 3. Permits are not valid until you receive a permit card. 4. Work must not begin unless thc permit card is available on thejob site. 5. Utility connection permits may be issued to licensed contractors only. 6. C�ontact the Public Works Department(952-249-4600)for utility stub as-built locations. DO NOT EXCAVATE IN ANY STREE'('AND DO NOT TAP ANY MAIN��ithout ezpress approval of the Public Works Department. Issuancc 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 beforc it is covered. Call (952)249-4600,24+hoin•notice required. TYPE OF PERMIT (Check All That A 1 ) ❑ Residential (May Re�uire Approval) ❑Commcrcial (Approval Required) ❑ New Connection ❑ Additional Connection ❑ Re-Connection ❑ Repairs �Disconnect ❑ Water Availability Connection For Futw•e Hook-Up to Water Job Site/Owner Information: Site Address: �� "�J �S�-U �� C�-A�� 1��a� Owner�h��1�(>C� Mailing Address: ��- C��j �C:��C ��i� �- ciry: `NC'�'�`Z-�-°�-- zip: `�5��1 � Home Phone: �(1 �� Alternate Phone: n�� Contractor Information: Contractor: �-�Y�`U,� �1�Cl�� Il��i Coi�tact Person: � ��Yl l�' �� Address: 3��1 ��U�t ��r1�' State Liceiise#: i City: �� Zip:�3� Expiratiou Date: Phone: �� l U� Altei7�ate Pho�7e: �D�� J��"o�� l , DETERMINING PERMIT FEES ❑ SAC Charge(2011 Rate=$2,230A0) $ (SAC Chargc must accompany all sewcr permit applications unless prepaid) (Orono City Staff can determine if applicable) (If not prepaid,a sewer connection permit�vill not be issued) � �❑ Sewer Connection/Disconnect/ Repair($SO.UU/Per Stub) $ � �� Pipe size � inches; matcrial ��I l.� Schd 40 air tested; cast iron ❑ Water Connection /Disconnect/Repair($50.00/Per Stub) $ �� •� Pipe sizc �� 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 futtn•e hook-up. This line will be inspected by the Public Works Deparm�ent. Required Before Water Connection Permit is Issued: 1. Issue Water Meter& Horn Permit 2. Any Additional Coni�ection Fees Paid(If Applicable) Issue Water Connection Permit: 1. Collect Permit Fee& Issue Water Connection Permit I. SUBTOTAL of Pcrmit Requested: $ ' V� � � 2. STATE SURCHARGE $ 5.00 3. POSTACE& HANDLING (Only on Mail-In Applications) $ 2.00 4. TOTAL PERM17' FEE(Add Lines I-3 Above) $ � �� , � ADDITIONAL INFORMATION—WATER METERS ■ WATER M ETERS must be pickcd up and paid for at Orono City Hall,thesc are on a sepaiatc permit. • WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon completion of ineter installation. The �mdersigned 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 tl�at all statements made on this application are, true and correct. Applicant: ��/��/w�� Date: Reset Form