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Home My WebLink About2014-00955 - sewer connect � - � CITY OF ORONO � 2750 KELLEY PARKWAY * 2 0 1 4 — 0 ID 9 5 5 * DATE ISSUED: 08/26/2014 ORONO, MN 55356- (952 249-4600 FAX: (952)249-4616 ADDRESS : 4315 NORTH SHORE DR PIN : 07-117-23-43-0028 LEGAL DESC : SAGA HILL REVISED : LOT 000 BLOCK 018 PERMIT TYPE : SEWER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION NOTE: SEWER CONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 COPPIN WATER&SEWER STATE SURCHARGE SEWER&WATER 5.00 864 QUAIL PKWY TOTAL 55.00 WATERTOWN,MN 55388- Payment(s) CHECK 4069 55.00 OWNER CLEVELAND,BRADLEY&PAT 4520 JUNEAU LANE N PLYMOUTH,MN 55446- AGREEMENT AND SWORN STATEMENT The work for which this permit is issued shall be performed according to the approved plans and specifications,applicable City 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 are requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. � ,` Gt�v�'`�- ��!^�l� /_t�t.c�K-� 8 �oZ lo� �� App�cant Permitee Signature Date Is d By Signature Date . � . FOR CITY USE ONLY -��^/� City of Orono Date Received: Permit# P.O.Box 66 ``' 2750 Kelley Parkway ❑In-House SAC Determination Form Completed i\ � , Crystal Bay,MN 55323 � �s'�� (952)249-4600/Pax(952)249-4616 Approved By(If Required): ,�A/�i:,��H, 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 is�ued when the auulication is received) GENERAL INFORMATION 1. You may apply for utility pennits 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 Warks 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 A 1 ❑ Residential(May Require Approval) ❑ Commercial(Approval Required) � New Connection ❑Additional Connection �Re-Connection ❑Repairs ❑Disconnect ❑ Water Availability Connection For Fnture Hook-Up to Water Job Site/Owner Information: Site Address: `��'� � S t�J ��E�� Owner:(�Cv,�\��I A �ic�� T('�� Mailing Address: �{ � S�,�c��,;� z,.,�J !�y City: (��c:�h zip: S Sy� �s Home Phone: �a.�3(�,q-�c�� Alternate Phone: Contractor Information: Contractor: Cc;��r. ��_� ,,,;�1�Q( Contact Person: g:�� ,P o� n Address: `z�tb`-i &.k�.� .,,.<v,� State License#: �`73'�.'�- M(Y City: �,�� ,,� Zip:�� Expiration Date: `�a,-3�- �� Phone: L\�--50�-`iq7�t Alternate Phone: , •. . DETERMINING PERMIT FEES ❑SAC Charge(2014 Rate=$2,485.00) $ (SAC Charge must accompany all sewer permit applications unless prepaid) (Orono City Staff can determine if applicable) (If not prepaid,a sewer connection permft will not be issaed) (�5ewer Connection/Disconnect/Repair($50.00/Per Stab) $ Pipe size�_inches;material�Schd 40 air tested; cast iron ❑Water Connection/Disconnect/Repair($50.0(I/Per Stab) $ Pipe size inch�;material Schd 40 air tested; copper ❑Water Availability For Fntnre Hook-Up to Water($50.00) $ Water Availabilitv Egulanation: Contractor installed line to inside of house for future hook-up. Ttris line will be inspected by the Public Works Department R�e uired Before Water CAnnection Permit is Issued: 1. Issue Water Meter&Horn Permit 2. Any Additional Connection Fees Paid(If Applicable) Issue Water Connection Permit: 1. Collect Pemut Fee&Issue Watsr 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 Lin� 1-3 Above) $ ADDITIONAL INFORMATION—WATER METERS ■ WATER METERS must he picked up and paid for at Orono City Hall,these aze on a seaarate�enni� ■ WATER METERS mnst be set and sealed by Orono Water Dep�rtment (952) 249-46011, upon completion of ineter installatioa. The undersigned hereby applies to the City of Otono for issuance of a Utility Permit,agrees to do all wark in strict accorda.nce with the ordinances of the City and the regularions of the State of Minnesota,and certifies that all statements made on this application aze,true and correct. Applicant:� C�,��..�� Date: �i—� —\�_ 1