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Home My WebLink About2015-01546 - sewer/water pass through fees with wayzata CITY OF ORONO * z 0 1 5 - 0 1 5 4`u 6� 2750 KELLEY PARKWAY DATE ISSUED: 12/10/2015 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 10 MYRTLEWOOD RD PIN : 36-118-23-33-0009 LEGAL DESC : MYRTLEWOOD : LOT 001 BLOCK 001 PERMIT TYPE : SEWER& WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : PASS THROUGH FEES- WAYZATA NOTE: THIS IS THE SEWER&WATER CONNECT[ON&SAC FEE FOR NEW HOME PERMIT#2015-01198 PAID VIA:CK#3315$2,767.00 FOR THE SEWER&WATER PASS THROUGH FEES APPLICANT SEWER CONNECTION CHARGE-WAYZATA 602.00 WATER CONNECTION CHARGE- WAYZATA 2,165.00 Chamberlain Capital LLC TOTAL 2,767.00 11578 CHAMBERLAIN CT Payment(s) EDEN PRAIRIE, MN 55344 CHECK 3315 2,767.00 OWNER Chamberlain Capital LLC 11578 CHAMBERLA[N CT EDEN PRAIRIE, MN 55344- 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 responsible for assuring all required inspections are requested in conformance with the State Building Code.This permit may be � revoked at any time for due cause. �� ,��, ��cs� '� � /�� f:� � �� /� �-_ — Applicant Permitee Signature Date Issued By Signa e Date o� n �� • ' � n � `�/ . �"�� =� `'j FOR�ITY USE ONLY '��Q-�IV��, City of Orono Date Received: ��!,�Permit� �� ( �'rj�`Q , P.O.Box 66 �� S ! 2750 Kelley Parkway �In-House SAC Determination Form Completed `'•�*,� t �'/ Crystal Bay,MN 55323 \�R,�.F�µ�j� (952)249-4600 Approved By(If Required): ��. '��___.- � � CITY OF ORONO—HOMEOWNER SUPPLEMENTAL FORM �O fj-� ( I� " WAYZATA- SEWER&WATER PASS THROUGH CONNECTION FEES & SAC FEES v (ALL PERMITS-Mav be subiect to further review and mav not be issued when the aaolication is receivedl �� I�I� PERMIT CODES(IN-HOUSE) Sewer/Residential/Pass Through Fees/Blank Water/Residential/Pass Through Fees/Blank Sewer&Water/Residential/Pass Through Fees/Blank GENERAL INFORMATION 1. SAC&SEWER&WATER CONNECTION FEES CAN'T BE PREPAID—LINLESS THE CONTRACTOR WILL BE PULLING THE PERMIT IN A FEW DAYS. (PER MET COUNCIL). 2. If payments are made: Prior to the actual sewer or water connection permit(pulled by the contractor)the payment will be held until that permit is received and paid for. 3. These payments can only be made with check or cash,because they are pass through fees. 4. If you the homeowner wants proof of this payment, we will hand write a payment receipt. 5. We will not hold this payment more than a few days to one week,at which time if the contractor does not come in we could reserve the right to return your check to you,or collect additional fees that could change. 6. Once the sewer or water connection permit is issued, we will issue this permit and send you the homeowner a copy. TYPE OF PERMIT Check All That A 1 �C Residential(May Require Approval) � New Connection ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address: (�'7 �Mv��\��.� „;� (1� Owner:c�,,,,,r�- >� 1 .:r,� k��, Mailing Address: 115�)��'' c�-�.:,�.�:1c.:,� � l City: t � r�� 'r-U�-�� Zip: �S,3``<<-I Home Phone: `�S�- [��l`� ��7(��3 Alternate Phone: . �`�v``��' . DETERMINING PERMIT FEES ❑ SAC Charge(2015 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 Charge—City of Wayzata(Pass Through Fee) $ (2015 Rate=$602.00) � Water Connection Charge—City of Wayzata(Pass Through Fee) $ (2015 Rate-$2,165.00) ❑ Water Connection Opt-Out—(Please Initial) I am choosing not to hook-ua to water at this time. ❑ Water Availability— (Please Initial) I am choosing not to hook-ua to water at this time. I have chosen to have my contractor make it water available for future hook-up. Water Availabilitv Exulanation: 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 TOTAL PERMIT FEE(Add Fees Listed Above) $ ADDITIONAL INFORMATION—WATER METERS ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a senarate permit. Typically the contractor will pick-up and pay for this 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 ardinances of the City and the regulations of the State of Minnesota, and certifies that all statements made on this application are,true and correct. ,� '� �, Owner: �<-�t�� i1/'� ��.J Date: %� ��6 �.