HomeMy WebLinkAbout2008-P12161 - sewer repair , ,, PERMIT
CITY OF ORONO
2750 Kelley Parkway- PO Box 66 Permit Number: p12161
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit
(952) 249-4600 Date Issued: 6/13/2008
SITE ADDRESS: 3685 North Shore Dr Unit#
Wayzata, MN 55391
PID: 08-117-23-34-0054
DESCRIPTION:
Proposed Use: Residential
Permit Class: General
Permit Type: Sewer and Water Permit Permit Sub-type(s): Sewer Repair
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
Sewer Repair
FEE SUMMARY: Permit Fee: $ 35.00 valuation: $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 35.50
APPLICANT: Roto Rooter Services Co. OWNER: Frank&Melissa Plachecki
14530 27th Ave.N. 3685 North Shore Dr
Minneapolis,MN 55447 Wayzata,MN 55391
THE UNDERSIGNED HEREBY REQUESTS PERMISSION TO MAKE THE REAL IMPROVEMENTS SPECIFIED
AND AGREES TO DO ALL WORK IN STRICT COMPLIANCE WITH ALL CITY OF ORONO ORDINANCES AND STATE OF
MINNESOTA BUILDING CODE REQUIREMENTS.
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APPLICANT PERMITEE SIGNATURE ISSUED BY SIGNATURE
Copies: 1-File(SignaturesRequired), ]-Applicant, 1-MonthlyReports, 1-Assessing,(IfSeptic, 1-Septic) Page 1
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FOR CITY.IISE O1�I�.Y
O,�Q�O City of Orono Dats Received: Persnit#
P.O.Box 66
2750 Kelley Parkway 0 In-House SAC DeterminaGon Form Completed
� � Crystal Bay,MN 55323 '
,��� (952)249-4600 Approued By(if Requiredj:
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 aoolication is received)
�ENERAI,I1�FORMATI�N
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 PEI�T
". . Checic A�1:Tliat A� 1
�.Residential(May Require Approval) �Commercial(Approval Required)
� New Connection ❑Additional Connection �Re-Connection �Repairs ❑Disconnect
Jc�b Site 1 iDwner Information: ;:
Site Address: ,���s /�/o�1 T�� �'yo�' �/?
Owner: ��/� C��L' l''�� ,,� Mailing Address:
City: �,//� �O Zip: Ss ,7 �/- �7l/
Home Phone: Alternate Phone:
Contractor Information: '
Contractor: � D jd /�p p��;� Contact Person: �D�
Address: / 5'.s�O „���9✓� i; State License#:
City: /"'�/! Zip:S��JExpiration Date:
Phone: Alternate Phone:
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� SAC Charge(2007 Rate=$1,675.00) $
(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($35.00/Per Stub) $
Pipe size inches;material Schd 40 air tested; 0 cast iron
❑Water Connection/Disconnect/Repair($35.00/Per Stub $
Pipe size inches;material Schd 40 air tested; � copper
1. SUBTOTAL of Permit Requested: $
2. STATE SURCHARGE $ .50
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 1.50
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
,ADDITIONA�, I'I�iFORl�1ATI�N '=WA'1'E�METERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate nermit.
■ 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 that all statements made on this application are,true and correct.
Applicant: 'i�� �_�� Date: �L�, � �
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