HomeMy WebLinkAbout2017-00579 - sewer & water connection CITY OF ORONO * Z 0 1 7 - 0 0 5 7 9 *
2750 KELLEY PARKWAY DATE ISSUED: 05/3U2017
ORONO,MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 797 BRIDGEWATER DR
PIN : 33-118-23-12-0021
LEGAL DESC : STONEBAY FOURTH ADDITION
: LOT O10 BLOCK 001
PERMIT TYPE : SEWER&WATER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : CONNECTION
NOTE: SEWER AND WATER CONNECTION
APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00
WATERCONNECT/DISCONNECT/REPAIR 50.00
BOLLIG& SONS, INC. STATE SURCHARGE SEWER&WATER 1.00
11401 COLTNTY ROAD 3
HOPKINS,MN 55343- S.A.C. 0.00
(952)93&4133 TOTAL 101.00
Payment(s)
CREDIT CARD 9081 101.00
OW1vER
Wooddale Builders
6117 BLUE CIRCLE DRIVE
MINNETONKA, MN 55343-
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 separate
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 res onsible for assuring all required inspections are
requested in co ance wit State Building Code.This permit may be
revoked at an i e for due c e.
� � -� f- t ' � ,�/ , l
Applicant Pe ee Signature Date Issued Signature Date
RECEIV�C�
�o-.,, M A Y � '� 2 O�� FOR CITY USE UAIT,'Y G}
� n!Q City of Orono ��M Dateitaceived: P�rmit#�1?- ' �� 7 /
P.O.Box 66
2750 Ke►ley Parkway ❑In•Hause SA�Detertnittatipn Form Cpmpleted
y ,� Crystal Bay,MN 55323 CITY 4F ORONO
'°r ��� (952)249-4600/Fax(95L)249-4616 ApproVed By(If Required):
qA� SHO� . . � . .
CITY OF ORONO-SEWER&WATER/GENERAL PERMIT
(*Note:Some permits 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 aonlication is received)
GENERAL INFORMATIQN
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 until you receive a permit card.
4. Work must not begin unless the pernut card is available on the job site.
5. Utility connecrion permits may be issued to licensed contractors only.
6. Contact the Public Works Deparhnent(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 QF PERMIT
Check Al1 That A 1
❑Residential(May Require Approval) ❑Commercial(Approval Required)
�w Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect
❑ Water Availability Connection For Future Hook-Up to Water
Job Site f t)wner Information:
Site Address: �`1 �' ��� � �i<=V-'G--�--'`-� � �
Owner: V`��a���� �-� Mailing Address:
City: �t'��^-G Zip:
Home Phone: Alternate Phone:
Contractor Infoz�rr�ation:
J
Contractor: '3v(I�.� <<�.,J� S o.� 5 Contact Person: �� ��-�l'�'
Address: �1 H U 1 C. ��l 3 State License#: '�b �� Y y �3
City: ������^S Zip:��� Expiration Date: � Z-- 3 , " ��'
Phone: `�S Z- ��� ���3 Alternate Phone: ��2 �S 11 2`t S�
❑SAC Charge(2016 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 Connection/Disconnect/Repair($50.00/Per Stub) $
;
Pipe size inches;material Schd 40 air tested; cast iron
�
�ater 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 Explanation:
Contractor installed line to inside of house for future hook-up.
This line will be inspected by the Public Works Deparhnent.
Required Before Water Connection Permit is Issued:
1. Issue Water Meter&Hom Permit
2. Any Additional Connection Fees Paid(If Applicable)
Issue Water Connection Permit:
1. Collect Pernut Fee&Issue Water Connection Permit
1. SUBTOTAL of Permit Requested: $
2. STATE SURCHARGE $ 1.00
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
` ADDITIONAL INFORMATION—WATER METERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate 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 City and the regulations of the State of
Minnesota,and certifies that all statements mad on this appli tion are,true and correct.
Applicant: Date: �' � � " ��