HomeMy WebLinkAbout2014-01051 - sewer connect ' ' CITY OF ORONO * z B 1 4 - 0 1 0 5 1 *
2750 KELLEY PARKWAY DATE ISSUED: 09/17/2014
ORONO, MN 55356-
(952) 249-4600 FAX: (9�2) 249-4616
ADDRESS : 1065 I,INDEN LA
PIN : 07-117-23-14-0066
LEGA[.DESC : LINDEN BEACH
: LOT 000 BLOCK 000
PERMIT TYPE : SEWER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : CONNECTION
NOTE: SEWER CONNECI'ION
APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00
STATE SURCHARGE SEWER& WATER 5.00
SCHERBER COMPANIES
11415 VALLEY DRIVE S.A.C. 0.00
ROGERS, MN 55374- MAIL-IN FEE 0.00
TOTAL 55.00
Payment(s)
CREDIT CARD 9805 �5.00
OWNER
KUZNIK,TONY&CARRIE
10690 ZIEGLERS DRNE
BROOKLYN PARK, MN 55443-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicablc City approvals,and the
State Building Code. "I'his 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 goveming[his type of work
shall be compicd 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 1 SO days at any time after work has commenced.
The applicant is responsiblc for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for d cause.
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Applican ermitee Signature Date Issued y Signature Date
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FOR CITY USE ONLY
j=y��-�71�(-� Cit�'of 01'ono Date Received: Pemut#
� '� P.O.Box 66 �fl.L
� �� � 2750 Kelley Parkway ❑In-House SAC Determination Form Complet'ed
�\: �� � , �-/ Crystal Bay,MN 55323 � ��e�� t
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�S� �'��'�� . ��l (952)249-4600/Fax(952)249-4616 Approved By(If Required): � ���
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CITY OF ORONO-SEWER& WATER/ GENERAL PERMIT
(*Note:Some permits may require approval by the Building Official ancLbr Public Works Department*)
(ALL PERMITS- Mav be subiect to further revieH and ma��not be issued when the apalication 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 unril 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 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 notice 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: ( UVJ-7 l�t�'���. l�' �
Owner:���,�n ��.� Mailing Address: ���� ��ne� �
City: ��il..�.� Zip: :}-���'��
Home Phone: '�1�L'� .����� (r,��� Alternate Phone:
Contractor Information:
Contractor: \ Contact Person: l�1 V
Address: � L � � State License#:
City: K`C�,�'s Zip'�S'>�� Expiration Date:
i �p� �
Phone: �l� . /��•���J Alternate Phone: ,�Q�'�v�--1 ��Z ��° ��(
DETERMINING PERMIT FEES
❑ SAC Charge(2014 Rate=$2,485.00) $
(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'�ganectioH!'Disconnect/Repair($50.00/Per Stub) $ ���. ����
Pipe size inches;material 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-tip to Water($50.00) $
Water Availabilit��Explanation:
Contractor instailed 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&Horu 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: $
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2. STATE SURCHARGE $ 5.00
3. POSTAGE&I�IANDLING(Only on Mai]-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ ��� ��'1 �
ADDITIONAL 1NFORMATION-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 Permit, agrees to do
all work in strict accordance with the ordinances of the Ciry and the regulations of the State of
Minnesota, and certifies that all statements made on this application are,true and correct.
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Applicant: Date: �� �