The URL can be used to link to this page

Home My WebLink About2012-00943 - sewer re-connect CITY OF ORONO * 2 0 1 2 — 0 0 9 4 3 * , , 2750 KELLEY PARKWAY DATE ISSUED: 09/19/2012 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 1370 CHERRY PL PIN : 08-117-23-32-0022 LEGAL DESC : SAGA HILL REV[SED : LOT 000 BLOCK O11 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : RE-CONNECT NOTE: SEWER RE-CONNBCTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 BURNS EXCAVATING, INC. STATE SURCHARGE SEWER&WATER 5.00 3470 CO. RD 21 TOTAL 55.00 MAYER, MN 55360- (612)685-4303 Minnesota State License#: 1888 OWNER NAFSTAD, ERIK 1370 CHERRY PL MOUND, MN 55364- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and speciftcations,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 permi[s. 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 no[ commenced within 180 days of the date of issuance,or if construction is suspended for a period of l80 days at any[ime after work has commenced. The applicant is responsible for assuring all required inspections are requested in conformance with the Sta[e Building Code.This permit may be revoked at any time for due cause. ./��- _ � / �9 / �z-' i � � � � pplicant Permitee Signature Date Issue [3y Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. � . FO/R}CITY USE ONLY �� City of Orono Date Aeceived:/�/i��,1'�mit# �/ ' 'Q'��' e.o.aoX�6 �� >��_ . �'�'� 2750 Kelley Parkway ❑In-House SAC Determinatiuo Form Completed � ys'�' +.'i Crystal Bay,MN 55323 '��,�o�� (952)24J-4600 Approved By(If Required): \��os,f CITY OF ORONO–SEWER&WATER/GENERAL PERMIT (*Note:Somc pcnnits may rcquirc approval by thc Building Official and/or Public Works Dcpartmcnt*) (ALL PERMITS- Mav be subiect to(urther review and mav not be issued when the apnlicatinn 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 Yo Yhe 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 Publie 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 A 1 �Residential(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 Informarion: , Site Address: 1�� T" ]��Zl��-�'��'. (.-- Owner: ��(Z l k /V��S�� Mailing Address: � ��`�� -1�.1Z��J� �1�'�% � ciry: �'��I/L t iL�L�l�r�l L��_ zip: �S �/ I �1 Home Phone: Alternate Phone: Contractor Information: Contractor: j�l.}IZ/ll� ��'�c:��lll'��1%1�� Contact Person: �7�'U E., ��L(�l�-�. Address: 3�f��.) �C� IZC.� Z� State License#: �� L- %�,, L�z ;S34c� Ciry: 1�-'1_��— Zip:�� Expiration Date: Phone: C ��z �S� -3/�Z Alternate Phone: C �P�� 1'�S _L� �>�, DETERMINING PERMIT FEES ❑ SAC Charge(2012 Rate=$2,365.00) � (SAC Charge must accompany all sewer permit applications unless prepaid) (Orono City Staff can determine if appLicable) (lf not prepaid,a sewer connection permit will not be issued) � �� Sewer onnection/ isconnect/Repair($50.00/Per Stub) $ `��-' Pipe size inches;material�Schd 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&Hoin Permit 2. Any Additional Connection Fees Paid(If Applicable) lssue Water Connecrion 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-ln 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 undersigned hereby applies to the City of Orono for issuance of a Utility Permit,agrees to do all wark 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. `1 �j � Z_ Applicant: _ � Date: �'yl/ �% �� Reset Form