HomeMy WebLinkAbout2011-00467 - sewer repair .. CITY OF ORONO PERMIT NO.: 2011-00467
, 2750 KELLEY PARKWAY
ORONO, MN 55356- �ATE IssuEn: 06/15/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 1450 CHERRY PL
PIN : 08-117-23-33-0016
LEGAL DESC : CRYSTAL BAY VIEW
: LOT 000 BLOCK 004
PERMIT TYPE : SEWER�
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : REPAIR
APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00
M P NEXLEVEL
500 COUNTY ROAD 37 WATER CONNECT/DISCONNECT/REPAIR 0.00
MAPLE LAKE, MN 55358- STATE SURCHARGE SEWER& WATER 5.00
(320)963-2400 MISC FEE 0.00
TOTAL 55.00
PAID W[TH CC# 7576
OWNER
SCHAIBLE, TODD&MICHELLE
1450 CHERRY PL
MOLTND, MN 55364-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,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
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 afrer 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.
`l� /'°lcti✓/ ^��.c,�.�'� 6 i lJ� �� l l
�plicant Permitee Signature Date Issued By S' ature ate
SEPARATE PERMITS REQUIRED FOR WORK OTHER AN DESCRIBED ABO .
FOR CITY USE 01LY
City of Orono Da[e Received: Pennit#
O�'��O\` P.O.[3ox 66
;�i 2750 Kellcy Park�vay ❑In-I louse SAC Detem�ination Porn�Completed
p`"�'P �� Crystal Bay,MN 55323
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��t� '�� o`; (952)249-4600
,. Approved By(If Required):
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CITY OF ORONO— SEWER& WATER/ GENERAL PERMIT
(*1ote:Somc pennits may require ap}�roval by the Building Official and/or Public Works Dcpaitment*)
(:AIJ. PF:KJII�I'ti- A�I;���he subiect to furlher revie���.ind ma�'not be issued when the anPlication is reccived)
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. Worl<must not begin unless the permit card is available on the job site.
5. Utility connection permits may be issued to licensed cont�-actors only.
6. Contact the Public Works Department(952-249-4600) far utility stub as-built locations.
DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN���ithout 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
(Gheck 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 Information:
1 �u
Site Address: � � � C�l���'''� �j�
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor: Y�� �V zX(p;;E � Contact Person:
Address: S Uc.� G�y, R�� 3 � State License#:
City: �� Zip: Expiration Date:
Phone: 3 2D- �6 3- Z�t�U Alternate Phone:
DETERMINING PERMIT FEES
❑ SAC Charge(2011 Rate=�2,230.00) $
(SAC Charge must accompany all sewer permit applications unless prepaid)
(Orono Ciry Staff can determine if applicable)
(If not prepaid,a sewer connection permit will not be issued)
❑ Se�ver Connect�on/Disconnect/Repair($50.00/Per Stub) $
Pipe size �--�` inches;material �z 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 hool<-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:
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 up and paid for at Orono City Hall,these are on a s�arate 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 Pennit, agrees to do
all work in strict accordance with the ordinances of the City anci the regulations of the State of
Minnesota, and certifies that all statements made on tl�is application are, true and correct.
Applicant i��� ,���� Date: �o � ��— ��