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HomeMy WebLinkAbout2008-P12118 - sewer repair PERMIT CITY OF ORONO 270 Kelley Parkway- PO Box 66 Permit Number: P12118 • Crystal Bay, Minnesota 55323 Permit Type: Sewer and Water Permit (952) 249-4600 Date Issued: 5/29/2008 SITE ADDRESS: 4040 North Shore Dr Unit# Mound,MN 55364 PID: 07-117-23-44-0092 DESCRIPTION: Proposed Use: Residential • Permit Class: General 4AA2 if Permit Type: Sewer and Water Permit Permit Sub-type(s): Sewer con 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: Coppin Plumbing OWNER: Timothy&LeAnn Deggendorf 8460 County Rd 15 4040 North Shore Dr Minnetrista,MN Mound,MN 55364 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. I. / APPLICANT PERMITE SIGNATURE ileSUED BY SIGNATURE Copies: 1-File(Signatures Required), 1-Applicant, 1-Monthly Reports, 1-Assessing,(If Septic, 1-Septic) Page 1 . FOR CITY USE ONLY O (� O City of Orono Date Received, Permit# P.O.Box 66 "� 2750 Kelley Parkway 0 In-House SAC Determination Form Completed . Crystal Bay,MN 55323 i'I t` , i (952)249-4600 Approved By(If Required): CITY OF ORONO—SEWER& WATER/GENERAL PERMIT (*Note:Some permits may require approval by the Building Official and/or Public Works Department*) (ALL PERMITS- May be subject to further review and may not be issued when the application is received) GENERAL INFORMATION 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 PERMIT (Check All That Apply) ®Residential(May Require Approval) ❑ Commercial(Approval Required) ® New Connection ❑Additional Connection 8 Re-Connections airs p E Disconnect Job Site/Owner"Information: Site Address: 11 0 1 0 1)0 V `, I r e C) T' Owner: 7r-1 OP—C o`J en clJ O r Mailing Address: LIO LE D r 'Co k-L��-t ,r w,- City: a c,3 o Zip: S—E3 b L Home Phone:CI S L t-7 Lf-ko Li 0 Alternate Phone: Contractor Information: Contractor: QC Q \(V Contact Person: '^Gtt C C' Address: L( n c _1 \ - State License#: 7 — L S City: 01, K he\e: s\c Zip CC3Sy Expiration Date: ` r)-, 3 \ - ©, Phone: (0 I-). `+-0 Lo 0- ")- v Alternate Phone: . ., . . :_ : . DETERMINING PERMIT FEES DI 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 035.00/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; 1 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 permit. • WATER METERS must be set and sealed by Orono Water Department (952) 249-4600, upon completion of meter 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,an4ertifies that all statements made on this application are,true and correct. � �p � �— a `� - cY Applicant: , 6,, "lam' Date: Reset Form