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Home My WebLink About2014-00915 - sewer/water disconnection ' � CITY OF ORONO * 2 0 1 4 — 0 PJ 9 1 5 * 2750 KELLEY PARKWAY DATE tsSU�n: 08/19/2014 ORONO, MN 55356- (952) 249-4600 FAX: (952) 249-4616 ADDRESS : 3865 NORTH SHORE DR PIN : 17-117-23-22-0002 LEGAL DF,SC : UNPLATTED 17 1 17 23 : LOT 000 BLOCK 000 PERMIT TYPE : SEWER& WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DISCONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 WATER CONNECT/DISCONNECT/REPAIR 50.00 J P SCHMITZ CONSTRUCTION COMPANY LL STATE SURCHARGE SEWER& WATER 5.00 16450 1 17TH AVE N MAPLE GROVE, MN 55369- TOTAL 105.00 Payment(s) CHECK 11650 ]05.00 OWNER DOBRATZ, MR. & MRS. MARK 3865 NORTH SHORE DR MOUND, MN 55364- AGREEMENT AND SWORN STATEMENT I�he work for which this permit is issued shall be performed according to [he approved plans and specifications,applicable City approvals,and the Sta[e Building Code. This pennit is for only the work described and does not grant permission for additional or related work which requires separate permits. Ail provisions of laws and ordinances goveming Ihis type of work shall be compied with whether or not specitied herein.This permit will expire and become n�Ql and void iY 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 are requested in conf �nce with the State Building Code.'This permit may be revoked at an e fo e. 1 '�J i � ��,�...� .� � � �� l� Ap ' nt Per itee,i n e a�e ssu By Signature Date J FOR CITY USG ONLY j��—�-f�\ City of Orono Date Received: Permit# � f '` P.O.Box 66 � � ❑In-House SAC Determination Form Com leted � �q } 2750 Kelley Parkway P ` rt � . ��/ Crystal Bay,MN 55323 ``•' ' '� -F 952 249-4600/Fax 952 249-4616 Approved By(If Requued): � f� ( ) ( ) CITY OF ORONO— SEWER& WATER/ GENERAL PERMIT (*Note:Some permits may require approval by the Building OfE7cia1 andlor Public Works Department") (ALL PERMiTS- Ma�bc subiect to further revieH and ma��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 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 a.s-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 A 1 ) ❑Residential(May Require Approval) ❑ Commercial(Approval Rec3uired) ❑New Connection ❑ Additional Connection ❑ Re-Connection ❑Repairs .�isconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: Site Address:.��`7J}.�i� �/�� Owner�,0(�(��/7��-� Mailing Address: City: Zip: Home Phone: Alternate Phone: Contractor Information: —�-� �� Contractor�.1 il-�� Contact Person: Addressl�� 7� i State License#: City: ��S�7C(T�i Zip:.'��y Expiration Date: Phone:��,j� L-�l�� Alternate Phone: L DETERMINING PERMIT FEES ❑ SAC Charge(2014 Rate=$2,485.00) $ (SAC Charge must accompany all sewer permit app]ications unless prepaid) (Orono City Staff can determine if applicable) (If not prepaid,a sewer connection permit will not be issued) � Sewer Connectio /Disconnec I Repair(�50.00/Per Stub) $ Pipe size inc , Schd 40 air tested; cast iron � Water Connectio 'sconne /Repair($50.00/Per Stub) $ Pipe size inches;material Schd 40 air tested; copper ❑Water Availability For Future Hook-tip to Water($50.00) $ Water Availabiliri�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: 1. 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 1NFORMATION—WATER METERS ■ WATER METERS must be picked up and paid for at Orono City Hall,these are on a separate qermit. ■ WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon completion of ineter instaliation. 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 c i i s that all tements made on this application are,true and correct. Applican . Date: