HomeMy WebLinkAbout2006-P10621 - sewer & water permit . PERMIT
�ITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: P1o621
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued: 12/7/2006
SITE ADDRESS: 751 Boulder Dr Unit#
Long Lake,MN 55356
PID: 33-118-23-11-0073
DESCRIPTION:
Proposcd Usc: Residential
Permit Class: General
Permit Type:
Sewer and Water Permit Permit Sub-type(s): Sewer&Water Connections
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
�
FEE SUMMARY: Pernut Fee: $ 70.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: Groth Water&Sewer OWNER: O.T. Development,LLC
775 Tower Drive 10300 lOth Avenue N#101
Hamel,MN 55340 Plymouth, MN 55441
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIF(ED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE W1TH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUfREMENTS.
APP ICANT PERMITEE SIGNATURE S ED BY SIGNATURE
Copies: 1-File(Signatures Required), l-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1
EOR CITY USE ONLY
��� City Of O1'Ono Date Received: Permit#
P.O.Box 6G
��•, � 2750 Kelley Park�vay ❑In-House SAC Determination Form Completed
� ��j���� �* Crystal Bay,MN 55323 A roved B If Re uired :
�t�� ,����,��o (952)249-4600 AP Y� 4 )
'�sasa$
CITY OF ORONO—S�WER & WATER/ GENERAL PERMIT
(*Note Some permits may require approval by the Building OfGcial and(or Public Works Department*)
(ALL PER��IITS- A�faV be subiect to further review and mav not be issued when the annlication is received)
GENERAL INFORMATION
1. You may apply for utility pennits by mail or in person at the City offices.
2. Mailed in applications are subject to the postage and handling fee shown below. Pernut cards wiil
be sent by rehuzi mail within 2 busuiess days.
3. Permits are not valid until you receive a pernut card.
4. Work must not begin unless the pernut card is available on the job site.
5. Utility connection permits may be issued to licensed conh�actors only.
6. Contact the Public Works Department(952-249-4600)for utility shib as-built locations.
DO NOT EXCAVATE IN ANY STREET AND DO NOT TAP ANY MAIN without express
approval of the Public VVorks Department. Issuance of a pemut does not grant this approval.
7. All work must be done in accordance with State Code requirements.
S. All work must be inspected before it is covered. Call(952)249-4600,24+hour notice required.
, TYPE OF PERMIT
(Check All That App1Y) '
�Residential(May Require Approval) ❑ Commercial(Approval Required)
�New Coimection ❑Additional Connection ❑Re-Connection ❑ Repairs ❑Disconnect
Job Site/ Owner Information:
Site Address: i r�f .U�� �c-� P�L���� 12-
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
,
Contract�{Q c� 4'� � Contact Person: �ll� f�/l��C'�
Address: � �Z_�t �.�i��� State License#: � ��
r` �
City: ���is��� Zip.�3T�xpiratioi� Date: � �/ 0 �
i
Phone: � ��__� C� � � Alternate Phoile: 7�� �� � � ���
- DETERMINING PERMIT FEES ':
❑ SAC Charge(2005 Rate=$1,550.00) �
(SAC Charge must accompany all sewer pernut applications unless prepaid)
(Orono City Staff can determuie if applicable)
(If not prepaid,a sewer connection permit�i�ili not be issued)
`�Sewer Connec ion/Disconnect/Repair $35.00/Per Stub) $
Pipe size�inches;inaterial Schd 40 air tested; cast iron
[�Water Conn ction/Disconnect/Repair(�35.00/Per Stub) $
Pipe size�inches; material�[�Schd 40 air tested; copper
� �
1. SUBTOTAL of Peniut Requested: $
2. STATE SURCHARGE $ .50
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50
4. TOTAL PERMIT FEE(Add Lules 1-3 Above) �
ADDITIONAL INFORMATION-WATER iVl"ETERS
■ WATER METERS must be picked up and paid for at Orono City Hall, these are on a separate pernut.
■ `�'ATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon
completion of ineter installation.
The undersi�ned hereby applies to the City of Orono for issuance of a Utility Pennit, agrees to do
� all work in sh-ict accordance with the ordinances of the City and the regulations of the State of
Minnesota, and certifies that all statements made on this ap�lication are,true and conect.
v
Applicant: Date: J �, � � O