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2007-P10889 - sewer repair
PERMIT CITY OF ORONO Permit Number: 2750 Kelley Parkway- PO Box 66 P1o889 Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit (952) 249-4600� ' � Date Issued: 4/13/2007 SITE ADDRESS: 3596 Livingston Ave Unit# Wayzata,MN 55391 PID: 17-117-23-43-0034 DESCRIPTION: Proposed Use: Residential Permit Class: General Permit Type: Sewer and Water Pernut Permit Sub-type(s): Sewer Repair DETAILS: Approved perresolution#: Separate permits required: NOTICES/REMARKS: FEE SUMMARY: Permit Fee: $ 35.00 valuation: $ 0.00 State Surcharge Fee: $ 0.50 Misc. Fee: $ 35.00 TOTAL FEE: $ 70.50 APPLICANT: Hagberg Exc. OWNER: Matthew Bollis 34497 Nacre St. 3596 Livingston Ave Princeton,MN 55371 Wayzata,MN 55391 THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF MINNESOTA BUILDING CODE REQUIREMENTS. �` � �� � ��� � ����� � �� __�� APPLICANT PERM[TE IGNAT ISSU BY SIGNATURE Copies: 1-File(Signatures Reguired), l-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, l-Septic) Page l � � �( � � /� � � . ,�' TOR CI'I'1'L1SE ONLY' � ,:��`�;,, C►ty Of OYOnO /� Date Received: Pemlit# !i, `y `� P.O.Box 66 �� �,� . �\';� 27j0 Kelley Park��ay a ❑In-House SAC Detennination Form Completed ��� tl''� �•�� Crystal E3ay,MN��323 � A ' �����}p4y`� (9�2)249-4600 Approved I3y(IfRcquircd): CITY OF ORONO—SCWE12 & WATER/ GENEI2AL PERMIT (*\ote:Some pennits may require approval by the Buildine Official andior Public\�✓orks Departmcnt*) (ALL PGRi�11TS- AIa��bc subiect lo fw-tl�cr revic�v:ind may not be issuccl�vhen thc��nnlicalion is rccei��cd) �GCNERAL INFORMA'1'fON 1. You may apply for utility permits by mai(or in person a: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 �vithin 2 business days. 3. Permits are not valid until you receive a perniit card. 4. �Vork must not be�in unless the pennit card is available on the job site. �. Utility connection permits may be issued to licensed contractors only. 6. Contact the Public Works Deparhnent(95?-249-=1600)for utility stub as-built locations. DO NOT EYCAVATE 1N AhY STR�E1'AND DO NOT TAP ANY iVIAIN without express �pproval of the Public Worl:s Dep�rtment. lssuance oFa permit does not grant this approval. 7. fUl work must be done in accordance with State Code requu�entents. 8. All �vork must be inspected before it is covered. Cail (952)2�9-4600,24+hour notice required. TYPC OF PERMIT (Checic All That A I ) '�Residential (May Require Approval) � Commercial(Approval Reqtiiced) � New C�oni�ection �, Additional Connection �]Re-Connection � Repairs � Disconnect Job Site / Owner Information: I �,-- `1 -,� . Site Address: � ,3_S'�(o L��,rc S fa r� ,�-v-2. �� Owiler: 1�G'���,ew L�o�� ,:� Niailiil� Acidcess: City: � �C�Y�l.�' 7ip: S _�'.3 �i � Home Phone: �� `—��/2, y Ll Sy niternate Phone: � Contractor I��formation: � C011tl'aCtOt': ��C✓( �C Contact Person: �ve �<6�°'� Address: s��1`�J/2%«^C S f State Liceilse #: Z�� ���1 City: Y,%�ce 7ip:� Expii•ation Date: — — — — �— I'llone: 7is'- Zh(� �-/�,/� Alternate Phone: � DETERMINiNG PERMIT FEES -� [� SAC Charge(2007 12ate=�1,675.00) $ (SAC Charge must accompai�y all sewe�r peril�it applications u��less prepaid) (Orono CiCy Staff can determine if applicable) (If not prepaid,a sewer connection permit will not be issued) ] Sewer Connection/Disconnect Re� ' ($35.00/Pei•Stub) $ Pipe size y�� inches; material SPJ, �w Schd 40 air tested; � cast iron ❑� W:iter Con�tion/Disconnect/Repair(�35.00/Per Stub) � Pipc size inches; material_ Schd 40 air tested; � copper 1. SUBTOTAL of Pen��it Requested: $ 2. STATE SURCHARGE $ .�(i 3. POSTAGE& HAIvDLING(Oniy on Mail-In Appiicatioils) S 1.50 4. TOTAL PEI2MiT FEE (Add Lines 1-, Above) $ ADD[T[ONAL INFORMATION —WATER METERS ■ �VA1'ER vI�TERS must be picked up and paid for at Orono City Hall,these are on a separate permit. � �Va"C�:R I��r'TERS must be set a��d sealed by Orono ��'�ke�� Uep���tmenk (9�21 24)-4600, upon completion of ineter installation. The undersigned hereby applies to the Citv of Orono for issuance of a Utility Permit, a�rees to do all worlc in strict accordance �vitil the ordinances of the City and tlle regulations of the State of Minnesota, and certifies that all statements made on this application are, true and correct. Applicant: Date: `�— �3—v 7 Reset Form ., � � ."� '� � • �� .. ;�y� . w � . a,0 Y � �l:�- - 'SF� * ����� � � .�. ����... d w ` 4�Y . . a. ' 3r►� : � �p ` �+pF.� '�r�fLw.Q�� µ . . ` � � :/' f=e� � � � � �;, , ,,��,, � �, s" � � ` '- ._ � ; t�" ... �,�. ! ,•'� .. �� � � # t : � r � - � ,� ��= 4�� �� ` +� �n` ' � �+' , .. �, v,- . 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