HomeMy WebLinkAbout2014-00423 - sewer connect CITY OF ORONO * 2 0 1 4 - 0 0 4 2 3 *
� 2750 KELLEY PARKWAY DATE ISSUED: OS/08/2014
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1575 MAPLE PL
PIN : 08-117-23-33-0032
LEGAL DESC : CRYSTAL BAY VIEW
: LOT Ol0 BLOCK 006
PERMIT TYPE : SEWER
PROPERTY TYPF. : RESIDENTIAL
CONSTRUCTION TYPE : CONNECTION
N07'E;: NEW SEWER CONNI�CTION
APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00
STATE SURCHARGE SEWER& WATER 5.00
J P SCHMIT'L CONSTRUCTION COMPANY LL TOTAL 55.00
16450 117TH AVE N
MAPLE GROVE, MN 55369- Payment(s)
CHECK 11566 55.00
OWNER
Maple Place LLC
550 25TH AVE N
ST. CLOUD, MN 56303-
ACREEMENT AND SWORN STATEMENT
I�hc work for which this permit is issued shall be performed accordine to
the approved plans and specitications,applicable City approvals,and the
State Building Code. This permit is t�or 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 specitied herein.This permit will
expire and become null and void if construction authorized is not
conunenced within 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time afier work has commenced.
The applicant is responsible for assuring all required inspections are
reques[ed in conformance with d�e State Building Code.This pennit may be
revoked af an �m for due c
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Applicant Permitee Signature Date Issue By Signature Date
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FOR CITY USE ONLY 3��
�-.��-���`4��, CiTy of Orono �ace Recei�efl: Permit#�l ��f
� P.O.Box 66
� ) 2750 Kelley Parkway ❑In-House SAC Determination Fonn Completed
,� �� Crystal Bay,MN 55323
�- r� '�`� �� ,�� (952)249-4600/Fax(952)249-4616 Approved By(If Required):
CITY OF ORONO—SEWER& WATER/ GENERAL PERMIT
(*Note:Some pennits may require approval by the Building Official and/or Public Works Department*)
(ALL PERMITS- �la��be subiect to further review and ma��not be issued when the aonlication is received)
GENERAL 1NFORMATION
1. You may apply for utility permits by mail ar 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. Wark 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. Contaet 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)
�w Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect
❑ Water Availability Connection For Future Hook-Up to Water
Job Site/Owner Information:
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Site Address: ���� !2��1��� �L��'Tc��--
Owner: /�� /�6�y��i�� Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor:-.�i�, �7 !6 (�'t� ��C.- Contact Person: `�l ��� ������_
Address: �� ���� //Z/�/T1 State License#: ���y�,�F��
City: ����l.C/ �� " Zip: ����Expiration Date: f�'�( /,�
Phone: ��fi3��C/� �! �(L� Alternate Phone:
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 Couuection/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 Availabilit��Explanatioo:
Contractor installed 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&Horn 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: $
2. STATE SURCHARGE $ 5.00
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�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 with the ordinances of the City and the regulations of the State of
Minnesota, and certifi t a tements made on this application are,true and co ect.
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Applicant: -� Date:
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