HomeMy WebLinkAbout2017-00502 (sewer & water) , CITY OF ORONO * Z 0 1 7 - 0 0 5 0 2 *
� 2750 KELLEY PARKWAY DATE ISSUED: 05/25/2017
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2510 CASCO POINT RD
PIN : 20-117-23-21-0016
LEGAL DESC : TOWNS[TE OF LANGDON PARK
: LOT 004 BLOCK 006
PERMIT TYPE : SEWER&WATER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : DISCONNECTION
NOTE: DISCONNECT ONLY
APPLICANT SEWERCONNECT/DISCONNECT/REPAIR 50.00
STONEWOOD, LLC WATERCONNECT/DISCONNECT/REPAIR 50.00
153 E LAKE STREET STATE SURCHARGE SEWER&WATER 1.00
WAYZATA, MN 55391- TOTAL 101.00
(612)462-4000 Payment(s)
Minnesota State License#: BUIL-BC594315 CHECK 14767 IOL00
OWNER
HART,MICHAEL&KRISTIN
2510 CASCO PT RD
WAYZATA, MN 55391-
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 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 responsible for assuring all required inspections are
requested in conformance wi[h the State Building Code.This permit may be
revoked at any time for due cause.
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Applicant Permitee Signature Date Issued By Signature Date
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'��NO�� City of Orono Date ltecei�ed: t" ,� Perm�t tl �G' l� �- ��'��-
; P.O.Box 66
; 2750 Kelley Parkway Q In-I�oase SAC Determination For�Completed
;� ,�-f Crystai Bay,MN 55323
`' � (952 249-4600/F� 952 249-4616 mved B
���,��.sHo��� ) ( ) APP Y(IfRtquircdj;
CITY OF ORONO—SEWER&WATER/GENERAL PERMIT �+�'�=��% ��s�"�
('Note:Some permits may require approval by the Building Official and/or Pubtic Works Departrnent•)
(ALL PERMTI'S• M�y be,c��hi.�.�r r�t��rrh�����and mav not be issaed when Me■���;��h �� riv�dl
GENE�tAI.INFORMATIOI�
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 retum 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.
S. 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 ezpress
approval o[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.
TY��OF PERA�T
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
Jo� Si�e/Ow�er Inforr�ation:
Site Address: _oZ5� D Gr9-S c�► r�'1� 1�.�
Owner: �`�1[-� t-}-�q-�'t` Mailing Address:
city: � ►2 0 ►vo ZIP; 5 S'3� �
Home Phone: 7G3 �°�=� ('-I� Alternate Phone:
Contracto.r In�orrnation:
Contractor: S`�a-rJ��,.�000 ,Lt_.L ContactPerson: SV� �,v5-r-�FSca►.J
Address: I S� � �},�, ST State License#: �L �q�-f�3��
Ciiy: t�J�1-`Pzrt-r+l—Zip:�lq1 Expiration Date:
Phone: (o �1=�v7���?c� Alternate Phone: � la,— �J6��'�joo�
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D�'�'��Il�3�PE�iIT FEE�a
❑ SAC Charge(2015 Rate=52,485.00) $
(SAC Charge must accompany all sewer permit applications unless prepaid)
(Orono City Staff can detemune if applicable)
(If not prepaid,a sewer connection permit will not be issued)
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�Sewer Connecti�/Disconnect./Repair($50.00/Per Stuti) $ S
Pipe size inches;material Schd 40 air tested; cast iron
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�Water Connecti n k isconnect/Repair($50.00/Per Stub) $ � t�[�
P i p e s i z e ches;mat�nal Schd 40 air tested; copper
❑Water Availability For Future Hook-Up to Water($50.00) $
Water Availabilitv Ezplaaation:
Contractor installed line to inside of house for future hook-up.
This line will be inspected by the Public Works Department.
RecLuired Before Water Connection Permit is Issued:
1. Issue VJater Meter&Horn Pemvt
2. Any Addi6onal Connection Fees Paid(If Applicable)
Issue Water Connecrion Permit:
1. Collect Permit Fee&Issue Water Connection Permit
1. SUBTOTAL of Permit Requested: $ ��� ' ��
2. STATE SURCHARGE $ 1.00
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ + •
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ _
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AD151TIONAL INFORMATION-WATER METERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate�ermit.
■ 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 w' h the ordinances of the CiTy and the regulations of the State of
Minnesota, and certifie all statements made on this application are,true and correct.
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Applicant: Date: