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Home My WebLink About2017-01332 - sewer/water connect CITY OF ORONO *I ' i)I 0N111 ' 2750 KELLEY PARKWAY DATE ISSUED: 10/17/2017 ORONO,MN 55356- (952)249-4600 FAX: (952) 249-4616 ADDRESS : 2625 KELLY AVE PIN : 20-117-23-14-0026 LEGAL DESC : TOWNSITE OF LANGDON PARK LOT 000 BLOCK 005 PERMIT TYPE : SEWER&WATER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : CONNECTION NOTE: SEWER AND WATER CONNECTION APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00 WATER CONNECT/DISCONNECT/REPAIR 50.00 J S SCOMPANIES,INC. STATE SURCHARGE SEWER&WATER 1.00 110300 LAMONT AVE NE HANOVER,MN 55341 MAIL-IN FEE 2.00 () TOTAL 103.00 Minnesota State License#:sept-L703 Payment(s) CHECK 8010 103.00 OWNER ELLEN REDMOND REVOC TRUST 2625 KELLY AVE EXCELSIOR,MN 55331- 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 separate permits. All provisions of laws and ordinances governing 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. (Y),(-- Q �pj ) /D / /7 / l 7 Applicant Permitee Signature Date Issued By S tature Date RECEIVED FOR CITY USE ONLY V..0^/O\ City of Orono OCT 1 8 20`t Date Received: Permit# `, P.O.Box 66 r' j 2750 Kelley Parkway ❑In-House SAC Determination Form Completed Crystal Bay,MN 55323 Cl F ORONO ?� % (952)249-4600/Fax(952)240-46 IT 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) ISAI Residential(May Require Approval) ❑Commercial(Approval Required) New Connection ❑Additional Connection ❑ Re-Connection ❑Repairs ❑Disconnect El Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: I/ Site Address: 2 4 2 7 kQ. 1/ 11 Owner: Kt'Ai. l U vl d iv vt S Mailing Address: Z/2-7 "(, C City: ic l:-Cil 5/0 i./ Zip: 5-S-3 3 / Home Phone: Alternate Phone: Contractor Information: Contractor: 3SS wa v C0 bt C Contact Person: et C j I/1/s It G Address: / 30 La. vio✓ l Ove(/FState License#: City: lit 0 id 1/ Zip:5S3 1/I Expiration Date: Phone: 7& 3 FZ(4 1.030 Alternate Phone: 7(0 3 Z Lf S 9 3 l 1p DETERMINING PERMIT FEES " ❑SAC Charge(2016 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 permit will not be issued) EP�j Ot) Sewer Connection/Disconnect/Repair($50.00/Per Stub) $ �� Pipe size 4' inches;material K Schd 40 air tested; cast iron 56dtl r Water Connection/Disconnect/Repair($50.00/Per Stub) $ Pipe size / inches;material X Schd 40 air tested; copper ❑Water Availability For Future Hook-Up to Water($50.00) $ Water Availability 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: $ l 01.) 2. STATE SURCHARGE $ 1.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ I Q -5 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 wi . he ordinances of the City and the regulations of the State of Minnesota,an. ce ifies that all me is made on this application are,true and correct. Applicant: ° 4 r Date: 10 I Z -11 SEWER& WATER PERMIT IN HOUSE FORM-TO HELP DETERMINE SAC UNITS FOR CITY USE ONLY (*Please Key This Information On Comment Line Of Permit*) Date Completed: #Of SAC Units Completed By: O *SAC Previously Paid- Permit# Date of Permit *Charge 1 SAC Unit Per Home *If Multiple Homes Or Units-May Need To Pay Additional SAC Charges ❑ *SAC Grandfathered In— Permit# Date of Permit *Must have had Hook Up&Home Prior To January 1, 1973 *Refer to Helpful Hint Sheets,Or Ask If Necessary *If Multiple Units-May Need To Pay Additional SAC Charges ❑ *Commercial— Permit#Accounted For Date of Permit ❑ *Letter From Met Council—Showing Use-Or Additional Units Needed- *Contact Jodi at(651)602-1113 To Obtain Letter(Usually Building Official Obtains) *Copies To:Lyle,Street File&One On Copy Of Permit For Reporting *If unable to determine;will have to wait to be issued until determination can be made ❑ SEPTIC Area- ***WATCH FOR THESE CONNECTIONS*** *Person Will Have To Pay Connection Fees&Assessments+SAC Charges *Refer To Current Year Fee Schedule! Don't Release Until Fees Are PAID! (Ask for Scott or Lin's Help With These) *Will Need Approval From Public Works(Scott) ❑ Special Grinder Pump Needed *Have Them Talk To Scott For Questions&Pricing *Give Them Special Hand Outs!(In Drawer With Sewer Permit) ❑ Permit Needs Approval From Public Works: Approved By: *Side note,Connection Permits—Cover Septic Tank Abandonment Also,Per Lyle