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HomeMy WebLinkAbout2013-01129 - sewer disconnection ' � �` CITY OF ORONO 2750 KELLEY PARKWAY * 2 0 1 3 - 0 1 1 2 9 * DATE ISSUED: 10/23/2013 ORONO,MN 55356- (952)249-4600 FAX: (952)249-4616 ADDRESS : 3320 NAVARRE LA PIN : 17-117-23-44-0059 LEGAL DESC : WILEYS NAVARRE ADDN LAKE MTKA : LOT 001 BLOCK 000 PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 MIKIE'S LANDSCAPING LLC WATER CONNECT/DISCONNECT/REPAIR 50.00 11039 COUNTY RD 16 STATE SURCHARGE SEWER&WATER 5.00 WATERTOWN,MN 55388- (612)221-3657 TOTAL 105.00 OWNER PASCUZZI,PAUL 3320 NAVARRE LA 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 sepazate 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 day at any time after work has commenced. The applicant's responsible for uring all required inspections aze requested in nfo ce wi e State Building Code.This permit may be re at r du e. ��3 � 13 � � Applicant Permitee gnature Date Issued y ature SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED A E. � , .. -� '� FOR CITY USE ONLY �����^/� City of Orono Date Received: Permit# � '. P.O. Box 66 i , ` 2750 Kelley Pazkway ❑In-House SAC Determination Form Completed ��, , � � Crystal Bay,MN 55323 ` �.� . l��:- (952)249-4600/Fax(952)249-4616 Approved By(If Required): hf:5l.�ti� � 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 aonlication is received) GENERAL 1NFORMATION 1. You may apply for utility permits by mail or in person at the City offices. 2. Maited 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 ❑ Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address: 3��(� JV a VtL�'Y� CCu'1� Owner: Mailing Address: City: �(�D��� Zip: Home Phone: Alternate Phone: Contractor Information: � > / r /� ` Contractor: � ( �j Q,S (,�S< l ontact Person: /� Gl'�1��'C``� r,� Address: II D�� C- �• �b,�G State License #: City: �� INh Zip:�s��Expiration Date: Phone: (/�a• ���• J��7 Alternate Phone: _!S�� 9sS. �S���, .. _ . �► DETERMINING 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 Connection/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 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: l. 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 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 ordinances of the City and the regulations of the State of Minnesota, and certifies t t all statement made on this application are,true and correct. 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