HomeMy WebLinkAbout2013-00432 - sewer/water connect � , .
CITY OF ORONO * 2 0 1 3 - 0 0 4 3 2 *
2750 KELLEY PARKWAY DATE ISSUED: OS/3U2013
ORONO, MN 55356-
(952) 249-4600 FAX: (952)249-4616
ADDRESS ; 3805 NORTH SHORE DR
PIN : 17-117-23-21-0029
LEGAL DESC : SHERRI LAKEVIEW ESTATES
: LOT 002 BLOCK 001
PERMIT TYPE : SEWER&WATER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : CONNECTION
NOTE: NEW CONNECTION WATER&SEWER
APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00
WESTONKA SEWER&WATER WATER CONNECT/DISCONNECT/REPAIR 50.00
6501 CO. RD 15
MOUND,MN 55364 STATE SURCHARGE SEWER&WATER 5.00
(952)472-4959 MAIL-IN FEE 2.00
Minnesota State License#: 1804 TOTAL 107.00
PAID WITH CC# 7464
OWNER
RACHEL,DON
3805 NORTH SHORE DR
MOLJND,MN 55364-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be perfortned according to
the approved plans and specifications,applicable Ciry 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 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections aze
requested in conformance with the State Building Code.This permit may be
revoked at any time for d cause.
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Applicant Permitee Si nature Date Issu By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
May 31 13 08:52a Westonka Mechanical 952-472-4961 p.2
� 05!`31/201'3 08:47 9522494616 IN�UNU rHv` uai c+�
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CITY OF 4RON0—SEWER& WATER t G�lYERAII PERMIT'
(•No1C:Some�ermits mor roquir�apprm�al by dx BufldingOfftCial:vlQ/ur Puhlic Works papt�rpMcnt•1
1wt L pERA1fTS I►t�y�e�ttbieet ro Nrthv rc.+ie.v�nd mar wat Q�issuod.vhcl�e6c�oMiuNAn x�ceived}
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t. Vou may apply for utiliry permits by�si;.or in persan at the Ciry officcs.
2. Mailed in app{ications���c sub,}sct tA thc postage and ltat�dlong f�e sbown bolow. Pxrn,it cards wilt
�e sern by rettirn mai)withm 2 businass days,
3. Permits are nut valid nntil yov receive a permit card.
4. Work must not L�egin uofess the pemiit c�trd is availab�e an tl�e jvb site.
5. Utility oonrtection permits may be iqsued to Iicensed c�ttnrkars onty.
6. Cantact the Publk Works Departrnent(952-249-46�0)�'or util3ty siub as-b�itt i�ations.
DD AIOT EXCAVA�'E IN ANY STRBET AND DO N07'?AP AIYY MAIIV wilhaut expre8s
approval of tlie P�blic Works Department. Issuance of a permit does nat grant tl�is approval.
7. All wark-nust be done in accordance witki 5tate Code requiremenu,
8. AU woek rnus[be inspected beft+n n is covered. CaU{952)249-+lbOtl,Z4+hou�aotice rcgaired.
- - _ . • - _ ="_ - _ :TYPE•QF.�ERM�'�i' - - -- _ - --- :��
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�Residcltial(May Requir+e Approvat) Q Commerciel(Approval Required)
�-New Connocrion ❑Addicinnal Co�,.+ection ❑ Ro-Cotmcction ❑Repairs E]1�isconnect
❑ Water Availability Connection.For Fut�Hook-Up To Wau:r
JaTi��,..rz�"'E�„','.;7:L�va�;f-In�'oi��i�``: _ -
Stte,Addtess: �
���.�,t;c�.j�-�;�, S��r�e �,���C�
Owner��,,.�i� �T��+,�.g ��� '� _-; �i'�'�.� Mailsng Addtess:
City: 7ip:
Hor�e Pho�n�: Altemate Phone:
F:�CI!'f�'�LtB�:iiifoii�axi�mi�i;_ ..
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Coniractor. �-+� 7�"" C�ntact Person: ��`� '�r�
Add�ess: ��lf C`.d. r�`-" � 5ffite License#:
City: �•�Ci�-� Zip:��� Expiration Date:
Phone: j��—'�7.�" ��f�l Alternate PUone: E��•�—~7��'?�� �'
May 31 13 08:52a Westonka Mechanical 952-472-4961 p.3
� S5�''J1120i�3 08:47 3522494616 ��► ' '"""`' """`
❑SAC Cfiarge(2013 Ra�=�Z.435.00) �
(SAC Charge must accompany a11 sswer per�nit appl�taticros untess prepaid)
(Orono City Staff can deterrnine if�licable)
(Ttaot prepuid,a uwer connectior pe��nit will rot b�'ss5ved�
❑Sewe�Conn �on!Diaconnect/TLepeir($SO.OAIPer Stvb) S
Fi��e size�inches;+nateTial�Sehd 40 airtested: cast�roa
❑ Water Connectiati/Di�coaaecl/Repair(��f1.011lPe�Stub) S
�'Ipe sixe � inchcs;materiaJ ''� Schd��air t�s�cd; copFcr
❑R'ater Availability For F�uture Hool�Up b Wab�er(S51L0(1) $
Water Availabilkv ExoIsrtatinn:
Contractor insutllcd Sinc to insicic af housc for f�ture hook-up.
'(l�ic line will be inspected by tha PubFic Warks 1�epartrnent.
�P��aired B�fore aLer Conn_ection Pemiit is issued:
1. TFsue Watc�Mcte�8t Hom Permit
2. Aay Additional ConnectiortFees Paid([f Applicabk)
icv�r Water Conneccion Permic:
I. CoEloa Pctenit Fec&(ssuc Water Cormection�ermit
1, SULt'I'O'�AZ.of Permit Requested: $
2. StATE SURCHARGE $ 5.00
3. POSTAGE&HANDLING(On(y an Mail-Tn A�lplications) S 2.00
4. TOTAL PERMIT FEE jA1dd Lines 1-3 AUpve) '�
-- � -- .� T��i� 'L'.�FORMA�" �1'�� �� ��� —��`�-�=�_ =�.:
te ;t
• W ATER MLTERS must be picktd v�p an�paid for at Oremo City Hall,thes�ar�c or�a senars aeTnt
• WA?ER MBTFRS mnst be set xnd senlcd by Orono wstes Dep�rtmcnt(952) 249-460Y, upon
completior of rrteter issgfallation.
The undoYsigned hereby a�plies to the City of Orono ft�r is5uance of a Utility Pcrmit,agrccs to do
all work in striet aceordance w'tth the�rciinaa�ces of the City and the regulations of the Statc o.f
Minnesota,and certifies diat a!1 statem ts made on t��is appliostian ar�,true and correct.
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�,ppliaaetk Date: