HomeMy WebLinkAbout2011-01454 - sewer repair �, CITY OF ORONO PERMIT NO.: 2011-01454
-f � 2750 KELLEY PARKWAY
ORONO,MN 55356- DATE ISSUED: 1U2U2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 4195 HIGHWOOD RD
PIN : 07-117-23-44-0022
LEGAL DESC : HIGHWOOD LAKE MTKA
: LOT 000 BLOCK 000
PERMIT TYPE : SEWER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : REPAIR
NOTE: SEWER REPAIR-4"PIPE SCHEDULE 40
APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00
OVERSON SEWER&WATER STATE SURCHARGE SEWER&WATER 5.00
P O BOX 247 MISC FEE 0.00
LORETTO,MN 55357-
TOTAL 55.00
OWNER
SMITH,DOUGLAS&ROBAN
4195 HIGHWOOD RD.
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 sepazate
permiu. All provisions of laws and ordinances goveming 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 res nsible for assuring all required inspections aze
requested in con m9nce with the State Building Code.This permit may be
revoked a �me f r due cause.
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Applic t er tee Signature Date Issue y Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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I�� City of Orono �a�.�� ��,���
���`�'� P.O.Box 66 � :-; � �� � � �:
2750 Kelley Parkway D�t1�T�uss,S+�.� namm►�'�r�7n C�tm}llettsd
a� ,. � Crystal Bay,MN 55323
"���p4� (952)249-4600 �ma'�'83'�I�`�teClu�Te�), � �,
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CITY OF ORONO—SEWER& WATER/GENERAL PERMIT
(*Note:Some peimits may require approval by the Building Official and/or Public Works Department*)
(ALL PERMITS- Mav be subiect to further review and mav not be issued when the aaolication is received)
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1. You may apply for utility permits by mail or in person at the City offices.
2. Mailed in applicarions are subject to the postage and handling fee shown below. Perxnit 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. Urility connecrion pernuts 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 without ezpress
approval of the Pubiic Works Department. Issuance of a pemut 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.
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❑ Residential(May Require Approval) ❑ Commercial(Approval Required)
❑ New Connection ❑Addirional Connecrion ❑Re-Connection �Repairs ❑Disconnect
❑ Water Availability Connection For Future Hook-Up to Water
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Site Address: Gl I Cl S� ��� S�'�G' � � ,�
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Owner: I�.'� ° �^ f `��/�� Mailing Address: �5 ��
City: ���i�.-�� Zip:
Home Phone: ��Z Z��� �y`� � Alternate Phone:
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Contractor: �(,-%�°^ ��� ��s �ontact Person: �� �1
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Address: �D �o� L�7 State License#: �1� `8��6 �
City: /��_ Zip:���5�Expiration Date: � l / L
Phone: ��1 �S/— �t��� Alternate Phone:
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❑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 will not be issued)
❑ Sewer Connection/Disconnect/Re,Pair($50.00/Per Stub) $
Pipe size �� inches;material�G,`*OSchd 40 air tested; cast iron
�yp�
❑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 Ezplanation:
Contractor installed line to inside of house for future hook-up.
This line will be inspected by the Public Works Department.
Required Before Water Connecrion Permit is Issued:
1. Issue Water Meter&Horn Pernut
2. Any Additional Connecrion Fees Paid(If Applicable)
Issue Water Connecrion Permit:
l. Collect Pernut Fee&Issue Water Connection Permit
1. SUBTOTAL of Pemut Requested: $
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2. STATE SURCHARGE $ 5.00
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
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■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate pernut.
■ 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 Pernut, agrees to do
all work in strict accordanc �th the ordinances of the City and the regulations of the State of
Minnesota, and certifie t all statements made on this application are,true and correct.
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Applicant: . Date: �/ Z� � �
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