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HomeMy WebLinkAbout2012-00305 - water connection . CITY OF ORONO 2750 KELLEY PARKWAY * � 0 1 z - 0 0 3 0 5 * DATE ISSUED: 04/23/2012 ORONO, MN 55356- 952 249-4600 FAX: 952 249-4616 ADDRESS : 70 MYRTLEWOOD RD PIN : 36-118-23-33-0018 LEGAL DESC : REG.LAND SURVEY NO.0446 : LOT 000 BLOCK 000 PERMIT TYPE : WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION NOTE: INSIDE WATER CHANGE OVER APPLICANT WATER CONNECT/DISCONNECT/REPAIR 50.00 WOODBURY MECHANICAL INC. STATE SURCHARGE SEWER&WATER 5.00 1988 STANICH COURT TOTAL 55.00 MAPLEWOOD,MN 55109- (651)777-7950 Minnesota State License#: PJ058638 OWNER SWANSON,JOSEPH 70 MYRTLEWOOD 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 applic t is responsible for assuring all required inspections are request n conformance with the State Building Code.This permit may be revo at any ti f e cause. � i �3 i � Lt.., i .� �-. Applicant Permitee Signature Date I s By Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. Apr 19 12 10:04a Woodbury Mechanical 651-770-7313 p.2 � Anr-16-�OIY 01:�10o Fron-CITY OF ORDIfC ;95ZI4i�16i6 T-52D P.001/GOt F-8AB o$p�,o c�cy n[orono r��teo�rv�$���'��. .,�Y . , ,-� ��`� P.�,Box6G ' • '' ;. �. �..• • '�� .' • • . :75�KNky Paricw�y ❑�n-F!'bute.Sl�;D��'f�inatiop Fonn Gbmpipoed - � � c��t a�r,n,ccv ss�v :.,.- . ,.,:L- . } ,. . , . , . . (9S1)249�4d04 ��y'�4,,;��; T •. � .1'�e CITY OF ORONO—SEW�R& vVAT�B/CENER,AI,AEI�MIT ('NeOt:S�ms permi�map�rrquire appr�l by�hc�uildina O!'Aeiu1 andlor Fublic Works Oepc��nrKnr ry [ALL PEItMII'�- �I(av ha aahiece m fu.��M�iew et m�v nec Ae tawed wh�e�Y�� ��ip ia raqivedl G�'IlVFOR�VlA•TION - • ��- ' � ' � . '' ' ,""��'� .,,. . , 1. You msy spply for utility parmirs 6y nosil or ia peeson at tbe Ciry vtfices. 2, Ma�ed ia applications are subject to the postage aad l�dliug fee show�o below. Pennii cords wiA ba seat by rcnun mail within 2 busiaoss days. 3. Permits aee not vaI[d ant�you reepve a perroit card. 4, Work must�rat begin�mles9 the parmit csrd is available on tha job site. S. UdGry cona�rcoon pzrtttits rmy be issued uo liceased codnracrors oNy, 6. Co�ct the Public Warks Dopaccmenc(952-249-4600}Caa�arility swb as-built]�xaaoAs. . DO NO'r�,�CCAVATE IN ANY STA��T AN�p01Y0��'AP�►NY MAW wit4ont rsprsss approvaL oi tAe Public Works Depsstmen� ]esuaoce of s pe�t doas not g;�nt dnis approval. 'I. All wort musc be doate in aecordaace with State Codc raquireauencs. 8. Al1 work musc be inspected bcfora i[is covered. Cail(952)249�600,�4thosr potiee nqutred. • � : . . . . , �;� ' Z;YpE"F}F PERIv1IT• : �. . • ; . . . . , � � . - . . :�� . �Chec�cAll�T'hatA� �1 � ':��� ' . , ����. � . . , . , . ��aenrast�May n.e�C�ovail 0 Co�ercial(App�,oval Requa�d) �New Co�ec�on []AdditioAa�Coaoecrioa ❑Re-Comaecdon ❑Repairs ❑Disconnect ❑ waco�Availability Conneccion For F�nue Hoo�c-Up[o Wa��7 Job Sitc/�vyncrT:i�onnatiou: " • . :' � . Site Address: 7o L.� w� Q. Owaer• �"o E' Si✓/�1'V.Soit/ Mailing Addiress: City: _��OA�U Z�p: � Home Phone; 9S1•�,39—d,�,t,f Alternate Phone: r'uOdtC9CWI TII�QIIIISt20II�� � ' . ,"' • ., ' Contcaccor: w��Y /�'�"CH_,�pc Can�act Person: �/� Address: r9��' STAJVI c,y� e.T' State Yacense#: .S—�6 � City: (/N� L e�w evp Zip:51'�o Facpiratiou Date: �—,�/— /.� Phane: GS7- 777-7 f.f d Alteraate Pbone: �/—77S d e Y`t— Apr 19 12 10:05a Woodbury Mechanical 651-770-7313 p.3 ;Apr-19-Z012 07:4fAm Fran-CITY OF OAONO +952Z414616 T-b20 P.00Z/OOZ F-3l6 .� ❑SAC Cleree(Z012 Ytate a A,,36S.0o) s (SAC C�arg,e�st socompmy all acwer permit applicstiosts unleu ptepeidl (Orono GSty Ss��'csa det�cr�iae if xpplicablc) (IT aot prepzid,a sewer cdnnee�ioa perm►t rrill oat be is�aed) �Sewer Consectino/Diatndneet/Repair(S50A0/Per Stub) $ Pip�size iriches;material Schd 40 eir tested; casc iroa �--� ❑WRter Connectioa/Diceonneet!Repair(s50.00lper Stab) S .���� Pipa size„�lncius;mareriel Schd 40 eir res=e�; copper ❑wacv Ava��va;�y For rbrure eso�c.u�ro ws���so.00� s ,�. . water Avslabilitv Emii�aiic� __ ....,... _. ! Contracsor iascaDed line io iaside othouse foar ti�ture 2�od�up. Ttiic line wili be iagpected by the Public Waks I?eparcraent. Rec�uiorcd BeFor�Water Com�ection Peimic is 9o�rrt; 1. Iseuo Waber.Meter�Hom pwndt 2. Aay Additioml Cemaecaon Fees Paid(If Applicebit) Iss�t, Waca Cnnaectian Permit: 1. Cv]lect Penmit Fee�Issue Watcr CoYurecoon Permit 1. SUBTOTAL of Petmit Requcst�d: g ,j D- �d 2. STAT�S[1RCHA[tG8 S 5.00 3. P�STaGE&HANDLtNG(Only on Mail-In qpplirations) S 2.00 4. TOTAL�ERMIT FEF,(Add Lis►cs 1•3 Abovt) � S,�.OZJ � ' � .�ADDl'�LONAL INFORMA�ION—•VVATER METERS' � � - WA1'S�U�TERS snust be picked up aad paid far at Oro�o C!ry Halt��hese are on a�te pe�nm;t. • '1K�A��1vI�T�R3 must be set sad ae�led by Orano Wster Depsrtmmt(952) 249-4600, npon eomp�etion of ineter ia�taltstaa. � Tho undcr'signed hereby aPplies m the City of Orono for issuance of a Utiliry Perm�t,a�to do all work in saict aeeordance with !he prdinartees of the City and the regttlations of the State of � Minne6ota,aad catifie�that all statcn�rnts mack an this appiieation sre,tnae and comct. , A�����: ' nat�: —/ S - /Z I Apr 1� 12 1Q:04a Woodbury Mechanical 651-770-7313 p.1 I ' ' ' � . . i �oadbur� �eehaw�ca4, �wc � ��a st��n ct � � MaPlew�ood� MN 55�Q9 I 65t 777-7950 Fan 651 i70-73�3 �i4X T72�4NSMiTT'}EL�ORJ�! ..:....-__.__.__.._._�::�- ._ .. _. ._. ... __ ._ _._.._._.._..r..------ , _�.::_.-:.... .__.s.,_ __. ........_..__.__,..�,�:—.. .._:._.:--..._..�- To: �� ��'7u� From: �/� - - .Name: ' Oebe Sent u ` �C: �.�G�L / �l`j ' /�— Phone: �S� -�%S- yGw Nurnber of Pages; Fauc �.�,? �y�—5�(v/� � r••:=.--..,..._.-.--.;_....___".�- n^�ssag�: � .�� � ' �c�.� � � �� , - �� f,� 1 - � � � � �. .� � �.�. �. ..._........_ ..� A 7 • / � J .. ,.%•. 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' P�)tk ' Tttese�must t�ve£,r�P�p,�el�a�'actar ar�r�tf�m a}tiand�fririri tfre dran�r�hmt See f� Suli�n� Reg.Land Su �r� �'+'���! l�: 000� T 5PfCTAlP�iO,�Ctt ' B�ock: 000 : �'e Iss� 'S�w�CtvYs�Cki�1 Per�: 1.t'�&P For f�rat�Corr�ection Permit 2,:F� �W r� ay iecti Y L�Y a�a 5ewer P"�ceG , �'.°'."�"'�`. �I�rr a�t�(Char�e x I�r:nf SAc un�ss,se�Pro�,2�si&t4rr�Yet�Fe���far U�fa�Z��)�I'hese ; � �� � ��sr�o�,�,����t��r-�d��c�y�,�rz�t���e��.sr�c�k��a�a � � � . ����������� �.{}�A��1lt?IfIt#�4L F�ES YfN,I Ct�.1.EtT IN F{�.t�ER BY CA'�i REt�STER&IP!PAR�EL�EEN QR�€fiAt�E.] aa�rr���70 ���� �� ��� � ���� � �' - � � �ore Tsainq��W�eC�ra�etia�Per�� �,Pulf�Pay Fa'(�q�,�V«�ter�tf�n P�t �, Pay�y�4�ayz�a� ��� strea: '�� � My�lewood Ra v+�'�k�n f��'ge�Gh�rge x is�,oF 5dc[�s,s�Pralect�fo 8�t[�r�veaz F�e 5c�lror;�da�at��.._'�, 3.W��'Meter&Wom�ermit to�+�ed Foe$��,4,(�emir�Th�m In�p�t�n��Als�N�cl ta t�[k�rE ��� �� ��� Wayzata (LOG Aid�A�DIII4NI�f�s*Y(NJJ��1.EC€IN��8'�CA�[R�GI51�It�=8e�l�'�C�t��+1 OR�FtA�I.� : � ' ���� � � 5,�If Ca�nectit�to W��;I+�P���a�d Pay€�t�ater I���}�bm,s��u�nk Year Fees. ��55391- ��1�� , I�twrndtinn�n+#�Rva�+P�:.tt�e are fsu p�n�s fa Future t�c,i�ta�t�i I�sue Oro�peni�t , 2.5d�e I�.tiu�w�i Eu�i�Tn�r jff I�is�rmit is i�d,the 6t�e i��k�l tahogxa btit home�rier ` ���'� t��t�c�C�to tf�e w�er sy�em,s�e t�tm w�ka avaia�k3r per'm�J �a yau war�t t�co�tnue?. r.l�diiian��dre�s ' r Adt�lioo�it�r�s Yes � , r AdtSli�tl Teru� ��/ ��y� i ��. . ..: . . . . �r ,. -�_ r � � /` ltiyYl�R '�.. 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