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HomeMy WebLinkAbout2017-00581 sewer & water CITY OF ORONO * z 0 1 7 - 0 0 5 8 1 * 2750 KELLEY PARKWAY DATE ISSUED: 05/3U2017 ORONO,MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 767 BRIDGEWATERDR PIN : 33-118-23-12-0089 LEGAL DESC : STONEBAY SEVENTH ADDITION : LOT 2 BLOCK 1 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 COLJNTY ROAD 3 HOPKINS,MN 55343- S.A.C. 0.00 (952)938-4133 TOTAL 101.00 Payment(s) CREDIT CARD 9081 101.00 OWNER Wooddale Builders Inc 6117 BLUE CR DR [JNIT#101 MINNETONKA,MN 55343- AGREEME1vT 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 goveming this rype of work shall be compied with whe[her or not specified herein.This permit will expire and become null and void if construction authorized is not commenced within 180 days of[he date of issuance,or if construction is suspended for a period of 180 days at any time after work has commenced. The applicant is responsi for assuring all required inspections are requeste conforman ith the State Building Code.This permit may be revoke at ny time for e cause. _ , �� _1 � �t'�e � %3 � 7 Applicant Permitee Signature Date ssued Signature Date RECEIV�C� ----� MAY 31 2017 FQR c�Tx vs�Q��,� ���-�� �'�� '�l�t� City of Qrono AateReceived: Perutit#���'—,�,,,-- � P.O.Box 66 2750 Kelley Parkway ���(QF ORONO ❑In-House SAC Detetmination Fonm Completed y � Crystal Bay,MN 55323 :Q "�,� p��� (952)249-4600/Fax(952)249-4616 Approved By(If Required): �CSHn � J CITY qF 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 receivedl GENERAL INFORMATICIN 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 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 QF 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 Jab Site/Owner Information: Site Address: �� �r'��t � w�--+�-�' � t— Owner: �����c��.f-.e..- Mailing Address: City: �r� �-�- cy Zip: Home Phone: Alternate Phone: Contractor Information: � ��` ' Contractor: � �r ��� �^-S Contact Person: ,/"l�� ��'�--•-�� � Address: ��y° � �� e-� 3 State License#: �� t(`��{ �"3 City: K�P�`''�S Zip:S S 3`r3 Expiration Date: � 2'.��- ��' Phone: y SZ y�� '���� Alternate Phone: �� 2 `�3 `� 2`�s`1 � � , � � � � ` ❑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) [�ewer Connection/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-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) $ ' ADDITIQNAL INFORMATION-WATER METERS ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate nermit. ■ 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 ordinan s of the City and the regulations of the State of Minnesota,and certifies th 11 statements e on this lication are,true and correct. � Applicant: Date: � �� � " � �' at ti ..• . • •o""" r . « �J. . a t } +t. g� {� r ...Ilk 411111M0111,1 .. -a 1 m { -, f 'rt ^y c,. ♦ , . a - r - �s h y -'4`,"",'-'',,y, . • • t.. ^ ,L 7.6' .: ' i-s . ' tit ":"_-7 R 1 �.,si T a' [:� -•:,. _ r - 4*-:,...,„„ .. • r} T 4 � r1y {.� yTF• - ;t iTyy ...,,V-'1"""2 , * f 'Y t • � • • � t 4 '-,..r ^ �� '‘.. ..c. ' • ��'_tom`'a �ti :. r rt` -• 'Y �_ �?� r**r`-t•.�"v? • ',"+ "'1111 .--�` ,zi, :. Z. x V.1,• 1 - - - 7„0,:t y _ ib " y - , t ir vim,,.•, ..,.V..,:4„..., • 1` fry- 7 - � j t rix ,� s � r'�`'- �'-, e C * ,, �: 'V."-.7......-,, :k J.K. • r, ;,'„!"-, .. 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