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HomeMy WebLinkAbout2013-00995 - sewer/water disconnect � ' � CITY OF ORONO * 2 B 1 3 - 0 P1 9 9 5 * 2750 KELLEY PARKWAY DATE ISSUED: 09/25/2013 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 2975 CASCO POINT RD PIN : 20-117-23-31-0045 LEGAL DESC : SPRING PARK : LOT 089 BLOCK 000 PERMIT TYPE : SEWER& WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTTON TYPE : DISCONNECTION NOTE: SEWER AND WATER DISCONNECT APPL[CANT 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# 9252 OWNER GOODWIN, KURT& BARBARA 7310 KURVERS POINT ROAD CHANHASSEN, MN 55317- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable City approvais,and the State Quilding Code. 'This permit is for only the work described and does not grant permission for additional or related work which requires separate permi[s. All provisions of laws and ordinances governing[his 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 time for due cause. /� Nw,�� � � � � � 13 ..� � �� � �5 r � � Ap—p�cant Permitee Signature Date Issued Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. . ' /�S � F C USE ONLY�v� !.J'S �-�/1/� City of Orono Date Received. L Permit# �' � � P.O. Box 66 1 27�0 Kelley Parkway ❑ [n-House SAC Determination Form Completed i i , Crystal Bay,MN��323 �'.,�Y� F�� (9�2)249-4600/Fax(952)2d9-4616 Approved By(If Required): K.sri��� CITY OF ORONO — SEWER & WATER/ GENERAL PERMIT (*Note:Some pennits may require approval by the Building Official and/or Public Works Department*) (ALL PER�IITS- N(av bc subject to further review and mav not be issued when the apn�ication is received) GENERAL INFORMATION L 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 Apply) �sidential(May Require Approval) ❑ Commercial(Approval Required) ❑ New Connection ❑ Additional Connection ❑ Re-Connection ❑ Repairs �i'�onnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address: �`17� ���-�o �• Owner: �C� Mailing Address: City: Zip: Home Phone: Alternate Phone: Contractor Information: Contractor: � -.5.j�l_ �,�(ti� . Contact Person: � � � �'►^n'�' Address: (��1 6 ���id-�M� State License #: �02-�7 `�£' City: ' Zip: Expiration Date: Phone: Co 5 I— ���O—I 3S� Alternate Phone: � �������'y 3�� ' i DETERN[INING 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 conn��ction permit will not be issued) �Sewer Connectio ��sconnect7�` epair($50.00/Per Stub) $ Pipe size inches; material Schd 40 air tested; cast iron �ater Connec���Di�sconnect/ pair($50.00/Per Stub) $ Pipe size incT'es;m�erial Schd 40 air tested; copper ❑ Water Availability For Future Hook-Up to Water($50.00) $ Water Availabilitv Explanataon: Contractor installed line to inside of house for future hook-up. This line will be inspected by che Public Works Department. RecLuired 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. 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 1-3 Above) $ ADDITIONAL INFORMATION—WATER METERS ■ WATER METERS must be picked�.p 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. _ ��`, /V✓U q Applicant: Date: l r°1'�� , ' %_i - . . ,`J'uJ � �i SG��I'i7.: : :r _ �-,,. - f � f.. �';�ffi.. , , � `� ;�:, r:'�•� �~ rr ,��� �'q,°d'_;s�� `' ' ....� � �'LI'���i��`",J'�/� 4 "� ,'.. A .�• • . , ` ' � ,..d� '� � .: , , �l . � i .r w �� ;�� �. � �1 �,�� o ¢��,�_. �ec�'"' �y� � ,� , , � 3��e[ '�� �+ � ;R��t'ff%'�'rati�.e�+,��"�;: � '� ��. � _ � ; -....y y� � �� � j s —--_,� • l- % �= -_ ...�..o—. — � �. - _ - _���... 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Call forthe next inspection 24 hours in advance. (952) 249-4600 OwnerlContractor on site: Inspector. White Copyllnspector's File Canary CopylSite Notice