The URL can be used to link to this page

Home My WebLink About2013-00017 - sewer disconnect ,r ••. . CITY OF ORONO * Z 0 1 3 - 0 0 0 1 7 * 2750 KELLEY PARKWAY DATE ISSUED: OU10/2013 ORONO,MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 4156 HIGHWOOD RD PIN : 07-117-23-44-0019 , LEGAL DESC : HIGHWOOD LAKE MTKA : LOT 023 BLOCK 000 � PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION NOTE: SEWER DISCONNECT APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 XPAND,INC. STATE SURCHARGE SEWER&WATER 5.00 13727 JOHNSON MEMORIAL DR SHAKOPEE,MN 55379- MAIL-IN FEE 2.00 (952)292-6107 TOTAL 57.00 Minnesota State License#:BC457158 PAID WITH CC# 4307 OWNER MUSGJERD,SCOTT&MELISSA 4156 HIGHWOOD RD MOLJND,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 sepazate 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 after work has commenced. The applicant is responsible for assuring all required inspections aze requested in conformance with the State Building Code.This permit may be revoked at any time for due ause. ' � � �� / / /o / /� App icant Permitee S' ature Date ssued y Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. s � FOR CITY LiSE ONLY � � .1�� City of Orono Date Received:� Pemtit# a�� " � � G r.o.soX 66 -I�-�{`�-__ , ' 2750 Kelley Parla��y ❑In-House SAC Deteimination Form Completed �, i a = Crystal Bay.MN 5533� ` ' ` (952)249-4600 Approved By(If Required): '-r!�•, tir. CITY OF ORONO—SEWER & WATER/GENERAL PERMIT (*1�ote:Some perniits may require appro�al by the Building Official and/or Public Works Department*) (ALL PERDITTS- :1fa��be subiect to further reviee�and mav not be issued when the aanlication is received) GENERAL INFORMATION 1. You may apply for utility pennits by mail or in person at the City ot��ices. 2. Mailed in applications are subject to the postage and handling fee shown below. Pennit cards will be sent by retum 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 connec[ion 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 STIiEET 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 notiee 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 Information: Site Address: � I`7 �,i' � lll�hV�ti):.i�� Owner: SCi.'� �J=�U11 P�� Mailing Address: �1�i� 1k1ti Y\.T��:-� �C{. Clty: �'1�(J'.`1iJ Zlp: �J,S,Z _� Home Phone: ��a' �� "�� Alternate Phone: Contractor Information: Contractor: ��?�Y��a � 1 tnL. Contact Person: `- �� Address: 1��'�"2:1 J u1nY►.��'1 State License #: ��.'-�� l�J55 ,/�1�y'yU;�(�� `�C. >`>j 1�l City: ��j�� ' a Zip:� Expiration Date: � 3� �� Phone: �1��- �� ' Cr3�lU� Alternate Phone: �;J��I- Z`�� «'� . � •� DETERMINING PERMIT FEES ❑ SAC Charge(2013 Rate=$2,435.00) $ (SAC Charge must accompany all sewer permit applications unless prepaid) (Orono City Staff can detertnine if applicable) (If not prepaid,a sewer connection permit will not be issued) �Sewer Connection Disconnect/ pair($50.00/Per Stub) $ �../� , 0� Pipe size inc�es;material Schd 40 air tested; cast iron ❑ Water ConnecNon/Disconnect/Repair($50.00/Per Stub) x Pipe size inches;material Schd 40 air tested; copper ❑ Water A��ailability For Future Hook-Up to Water($,50.00) $ Water Availabilitv Exnlanation: 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 Pennit is Issued: l. Issue Water Meter&Horn Pennit 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Connection Permit: 1. Collect Pennit Fee&Issue Water Connection Permit l. SUBTOTAL ofPennit Requested_ � �0, � � 2. STATE SURCHARGE � 5.00 3. YOSTAGE&HANDLING(Only on Mail-In Applications) $ �0 4. TOTAL PERMIT FEE (Add I,ines 1-3 Above) $ S�� ADDITIONAL INFORMATION—WATER METERS ■ WATER�'IETERS must be picked up and paid for at Orono City Hall,tl�ese are un a separate permit. ■ ��'ATER METERS must be set anci sealed by Orono Water Department (9S2) 249-4600, upon compleNou 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. Applicaut: !/ Date: j ' �' �� `..