The URL can be used to link to this page

Home My WebLink About2012-00144 - water connection CITY OF ORONO * Z QJ 1 2 — 0 0 1 4 4 * 2750 KELLEY PARKWAY DATE ISSUED: 02/22/2012 ORONO, MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 30 MYRTLEWOOD RD PIN : 36-118-23-33-OOl 1 LEGAL DESC : MYRTLEWOOD : LOT 003 BLOCK 001 PERMIT TYPE : WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION NO"I'1',: WATER CONNEC"I'ION-PIPE SIlE; 1" -SCHEDUI_,E 40 APPLICANT WATER CONNECT/DISCONNECT/REPAIR 50.00 MUSKA PLUMBING STATE SURCHARGE SEWER&WATER 5.00 1985 OAKCREST AVE ROSEVILLE, MN 55113- TOTAL 55.00 (651)286-0056 PAID WITH CC# �+10 Minnesota State License#: 60919-PM C�J�'�� OWNER PAULSON, BRUCE& LORI 30 MYRTLEWOOD RD WAYZATA, MN 55391- AGREEMENT AND SWORN STATEMENT 'I'hc 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 specitied 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 fo due cause. �, / �,7�./'�.O`2 �% a'�`-/ / A licant Per itee Signature Date Issue y Signaturc Date SEPARATE PERMITS REQUIRED FOR WORK OT ER THAN DESCRIBED ABOVE. . . . � F�, CI USE ONLY . / 4�� City of Orono Date Received;� 2 Permit# �D/a—p /'f`� P.O.Box 66 ��;,ti,�,,a � 2750 Kelley Parkway ❑ In-House SAC Determination Form Completed ' a ;�j'�?��' Crystal Bay,MN 55323 �1t�. � � '?t.,��s,�C.yo (952)249-4600 Approved By(If Required): ��Hp6 CITY OF 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 aon��cation is received) GENERAL INFORMATION 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 OF PERMIT (Check All That Apply) � � �f Residential(May Require Approval) ❑ Commercial(Approval Required) �New Connection ❑Additional Connection ❑Re-Connection ❑ Repairs ❑ Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/ Owner Information: ---� Site Address: 3� 1'� r/R�-�e.�wc5e,c�, f�d � Owner: �.d R l �Ntu lsanl Mailing Address: S �i w.� c�ty: t�v�y�-��-� z�p: �5 39l Home Phone: 9S�" �13'd22) Alternate Phone: Contractor Information: Contractor: M USI��q ��U wcbi� Contact Person: �n��c��Y V'OS�(Z Address: I�18rJ a.�ke.�.as� �lde• State License#: b�C7'�Cf-"�1M. c�ty; ��e�i I le Zip:�S/�Expiration Date: ��,""3�"' �b�� Phone: J-,�S (-`�g�b-f�(�5,(, Alternate Phone: _ �� 1�'�3(- ')�5 *'� ` � ;;,°� DETERMINING PERMIT FEES 'I ❑ SAC Charge(2012 Rate=$2,365.00) $ (SAC Charge must accompany all sewer permit applications unless prepaid) (Orono Ciry Staff can determine if applicable) (If not prepaid,a sewer connection permit will not be issued) ❑ Sewer Connection/Disconnect/Repair($50.00/Per Stub) $ Pipe size inches;material Schd 40 air tested; cast iron �Water Conneetion/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 Pernut 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Connection Permit: 1. Collect Permit Fee&Issue Water Connection Permit 1. SUBTOTAL of Pernut Requested: $ �d� �(J 2. STATE SURCHARGE $ 5.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ .399�a 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 s�arate pernut. ■ 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 far 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 certifies that all statements made on this application are,true and correct. Applicant: Date: �—��'-' �)�