HomeMy WebLinkAbout2011-00468 - sewer repair ' CITY OF ORONO PERMIT NO.: 2011-00468
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE �SSUED: 06/15/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 1470 CHERRY PL
PIN : 08-117-23-33-0017
LEGAL DESC : CRYSTAL BAY VIEW
: LOT 000 BLOCK 004
PERMIT TYPE : SEWER
PROPERTY TYPE : RESIDENTIAL I/
CONSTRUCTION TYPE : � Q�Q,�����
NOTE:
SAC GRANDFATHERED IN
DOUBI,E FEE-WORK DONE WITHOUT A PERMIT
APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00
M P NEXLEVEL STATE SURCHARGE SEWER&WATER 5.00
500 COUNTY ROAD 37
MAPLE LAKE, MN 55358- MISC FEE 50.00
(320)963-2400 TOTAL 105.00
PA1D WITH CC# 7576
OWNER
BWB Holdings LLC
3800 AMERICAN BLVD W#]00
BLOOMINGTON, MN 55431-
AGREEMENT AIYD 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 pemiit will
expire and become null and void it�construction authorized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for a period of I 80 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in confom�ance with the State Building Code.This permit may be
revoked at any time for due cause.
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pplicant Permitee Signature Date [ssued y Si ature
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO .
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Clt of Orono Date Rcccived: Pcnnit#
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���>� ��� 2750 Kellcy Park���uy ❑In-I Iouse SAC Detcnnination Form Complcted
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�� � , o�� (952)249-4G00 Approved By(If Required):
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CITY OF ORONO— SEWER& WATER/ GENERAL PERMIT
(*Note:Some pennits may require approval by the Building Official and/or Public Works Department*)
(ALL PER�tI"fS- �1a��be subiect to further review and mav not be issued when the annlication 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 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�vithout express
approval of'the Public Works Department. Issuai�ce 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)
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❑ New Connection ❑ Additional Connection ❑ Re-Connection �Repairs ❑ Disconnect
❑ Water Availability Connection For Future Hook-Up to Water
Job Site /Owner Information:
Site Address: � � 7('' �1��.�y %l
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
Conhactor: ��� /�/tk�1� � Contact Person:
Address: ��� L�y_ 0�� 3 7 State License #:
h.
City: J�1� j . � � Zip: '� �3��Expiration Date:
Phone: 3 ZC7-- �J b 3 -2Yc'� Alternate Phone:
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DETERMINING PERMIT FEES
❑ SAC Charge(2011 Rate=$2,230.00) $
(SAC Charge must accompany all sewer permit applications unless prepaid)
(Orono City Staff can determine if applicable)
(If'not prepaid,a sewer connection permit�vill not be issued)
❑ Sewer Connection/ Disconnect/ Repa�r�$50.00/Per Stub) $
Pipe size�inches;material �r,/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& Horn Permit
2. Any Additional Connection Fees Paid(If Applicable)
Issue Water Connection Permit:
1. Collect Permit Fee&lssue Water Connection Permit
1. SUBTOTAL of Permit Requested: $
2. STATE SURCHARGE $ 5.00
3. POSTAGE&HANDLING(Only on Mai]-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 separate permit.
■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon
completion of ineter installation.
Tlie undersigned hereby applies to the City of Orono for issuance of a Utility Pennit, agrees to do
all work in strict accordance with tl�e 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: � " l� /,.�� Date: � l�5 ��