HomeMy WebLinkAbout2013-00121 - sewer disconnect t
' `" CITY OF ORONO * z 0 1 3 — 0 B 1 z 1 *
2750 KELLEY PARKWAY �ATE �SSUED: 02/20/2013
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1545 MAPLE PL
PIN : 08-117-23-33-0029
LEGAL DESC : CRYSTAL BAY VIEW
: LOT 007 BLOCK 006
PERMIT TYPE : SEWER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : DISCONNECTION
NOTE: D[SCONNECT ONLY
APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00
WESTONKA SEWER& WATER STATE SURCHARGE SEWER& WATER 5.00
6501 CO. RD 15
MOUND, MN 55364 TOTAL 55.00
(952)472-4959 PAID WITH CC# 7464
Minnesota State License#: 1804
OWNER
Maple Place LLC
550 25TH AVE N
ST. CLOUD, MN 56303-
AGREEMENT AND SWORN STATEMENT
"I�he 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 ifconstruction 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 the State[3uilding Code.This permit may be
revoked aiany time for use. �f,j
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A�icant Permitce Signature Date ►ssued By Signature Date
SEPARATE PERM[TS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
.*
FOR CIT1`USE ONLY
.� ��� � City Of�1'On0 Da[e Received: Permit# �L
� �1 P.O.F3ox 66 ' �(,� � �
' 2750 Kelley Parkway ❑ In-House SAC Dctermination I'orm Completed �
�'��� �% Crystal Bay,MN 55323
���°�,`r ,� , ,y�j (952)249-4600 Approved By Qf Required):
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CITY OF ORONO —SEWER & WATER/GENERAL PERMIT
(*Note:Some permits may requirc approval by the Building Official and/or Public Works Department*)
(ALL PERMITS- Mav be subiect to further review and mav not bc issued when the aonlication is received)
GENERAL INFORMATION
I. 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 OF PERMIT
(Check All That Apply)
.�-
��Residential (May Require Approval) ❑ Commercial (Approval Required)
❑ New Connection ❑ Additional Connection ❑ Re-Connection ❑ Repairs �•,pisconnect
❑ Water Availability Connection For Future Hook-Up to Water
Job Site/ Owner Information:
Site Address: ������� � (����%��' ���s�
Owner:,��-t �) �� ��.sD� �PS Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
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Contractor: � ��5���✓� ��' � Contact Person: � c � �
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Address: �� v � `'�1 �� � State License #: �
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City: ��Lu Zip�-��Expiration Date:
Phone: �-/.��� -� �.� '� Alternate Phone: �'�-�- ���-�17��I
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' DETERMI�iING'PERMIT FEES'
❑ SAC Charge(2013 Rate=$2,435.00) $
(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 Connectio 9�bisconnect%/Repair($50.00/Per Stub) $
Pipe size�che's;�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 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& [ssue Water Connection Permit
1. SUBTOTAL of Permit Requested: $
2. STATE SURCHARGE $ 5.00
3. POSTAGE& HANDLING(Only on Mail-[n 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 ordi ances of the City and the regulations of the State of
Minnesota, and certifies that all stateme s r�ade on this application are,true and correct.
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Applicant: ` Date: ���(�— ' �