HomeMy WebLinkAbout2005-P08672 - sewer/water disconnect r . •
PERMIT
C I TY O F O RO N O Permit Number:
2750 Kelley Parkway- PO Box 66 P08672
Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Pernut
(952) 249-4600 Date Issued: si3i2oos
SITE ADDRESS: 3805 North Shore Dr
Mound,MN 55364
PID: i�-ii�-23-2i-000i
DESCRIPTION:
Proposed Use: Residential
Perxnit Class: General
Pemut Type: Sewer and Water Permit Permit Sub-type(s): Sewer&Water Disconnectic
DETAILS:
Approved per resolution#:
Separate permits required:
NOTICES/REMARKS:
FEE SUMMARY: Permit Fee: $ 70.00 Valuation• $ 0.00
State Surcharge Fee: $ 0.50
TOTAL FEE: $ 70.50
APPLICANT: Widmer Construcrion LLC OWNER: 7ames Powers
9455 County Rd. 15 3805 North Shore Dr
Maple Plain,MN 55359 Mound MN 55364
THE UNDERSIGNED HEREBY REQUESI'S 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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CANT PERMTI'EE SIGNATURE SUED BY SIGNATURE
Conies: 1-File(SiQnitures Required), 1-Avnlicant, 1-Monthlv Reports, 1-Assessin�, 1-Finance Page 1
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� FOR CITY USE ONLY
,��� City of OrOno Date Received: Permit#
O r � P•O.Box 66
#,;.; 2750 Kelley Parkway ❑In-House SAC Determination Form Completed
� ��j�'?'�:-" � Crystal Bay,MN 55323
�^ �T�j��;��o (952)249-4600 Approved By(If Required):
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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 application is received)
GENERAL 1NFORMATION
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 rehun mail within 2 business days.
3. Permits are not valid until you receive a permit card.
4. Work must not begin unless the peimit card is available on the job site.
5. Utility connection peimits 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 pernut 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 Connecrion ❑Additional Connection ❑ Re-Connection ❑Repairs ' connect
Job Site/ Owner Information:
Site Address: ,� �J�'--� /�C>,�'...f� ������_ ,��. ���-
Owner: Mailing Address:
City: ���c:� Zip:
Home Phone: Alternate Phone:
Contractor Information:
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Contractor: Glf��%�.- �������;�-� Contact Person: �,✓✓ � �.������d���
Address: f'y����� � �is� State License #:
City: �'�����'%``j"� Zip:.>S-��%Expiration Date:
Phone: `�S��- �'�.s ' S°�� Alternate Phone: ��G'�.s"��L`-/G��
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DETERIVI]NING PERMIT FEES
❑ SAC Charge(2005 Rate=$1,450.00) $
(SAC Charge must accompany all sewer peimit applications unless prepaid)
(Orono City Staff can deternune if applicable)
(If not prepaid,a sewer connection permit will not be issued)
�Sewer Connection Disconnect epair($35.00/Per Stub) $
Pipe size in , erial Schd 40 air tested; cast iron
�Water Connectio /Disconnect/R ir($35.00/Per Stub) $
Pipe size n c es; 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) $
ADDITIONAL INFORMATION-WATER METERS
■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate uernvt.
■ 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.
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Applicant•��-,�� �rn—,�c,,.G��t Date: �-�—�.Z�;,
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