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HomeMy WebLinkAbout2017-01194 - water connection CITY OF ORONO * 2017 - 01194 * 7 2750 KELLEY PARKWAY DATE ISSUED: 09/25/2017 ORONO,MN 55356- 952 2494600 FAX: 952 249-4616 ADDRESS : 685 OLD CRYSTAL BAY RD N PIN : 33-118-23-21-0002 LEGAL DESC : UNPLATTED 33 118 23 : LOT 000 BLOCK 000 PERMIT TYPE : WATER PROPERTY TYPE : INSTITUTIONAL-SCHOOL CONSTRUCTION TYPE : CONNECTION NOTE: WATER CONNECTION-PIPE SIZE 6",MATERIAL 0900 APPLICANT WATER CONNECT/DISCONNECT/REPAIR 50.00 STATE SURCHARGE SEWER&WATER 1.00 HOBS EXCAVATING TOTAL 51.00 PO BOX 42 ELK RIVER,MN 55330- Payment(s) (763)241-3908 CHECK 4857 51.00 OWNER SCHOOLS,ORONO PUBLIC 765 OLD CRYSTAL BAY RD N LONG LAKE,MN 55356- 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 assuming all required inspections are requested in conformance with the State Building Code.This permit may be revoked at any time for due cause. nri��i/7 Applicant Petznitee Signature Date Issu By Signature Date FOR MY USE ONLY City of Orono Date Received: Permit# P.O.Box 66 2750 Kelley Parkway ❑In-House SAC Determination Form Completed Crystal Bay,MN 55323 r` c (952)249-4600/Fax(952)249-4616 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 PERMTTS- 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) ,VNew Connection ❑Additional Connection ❑Re-Connection ❑Repairs ❑Disconnect ❑ Water Availability Connection For Future Hook-Up to Water Job Site/Owner Information: I / Site Address: �1� C l' Tom( Owner:`f I'4 4'0 5,40015 Mailing Address: City: d r-On D Zip: 5 �� Home Phone: Alternate Phone: Contractor Information: Contractor: ���� � � t,� Contact Person: ✓J Address: jI �Q� `! State License#: City: G �/���' Zip:53)W Expiration Date: Phone: lb-^ o'-V1 P Alternate Phone: 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) ❑Sewer Connection/Disconnect/Repair($50.00/Per Stub) $ Pipe size inches;material Schd 40 air tested; cast iron Water Connection/Disconnect/Repair($50.00/Per Stub) $ Pipe size 6' inches;materialG�Schd 40 air tested; copper ❑Water Availability For Future Hook-Up to Water($50.00) $ Water Availability Ezolanatiou: 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 $ 1.00 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $ 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 with the ordinances of the City and the regulations of the State of Minnesota,;andffles that all statements made on this application are,true and correct. Applicant. ice 1Wf e /"/f��� Date: �� �/ 7 SEWER&WATER PERMIT IN HOUSE FORM-TO HELP DETERMINE SAC UNITS mit CI''t'v Ust"Ly (*Please Key'This l'nf nwition on Comment Eine Of PeatOr *) Date Completed: #1 Of SAC Units _ Completed Ely: *SAC Previoasty Paid- _Perluit# mate of Permit. '"'Charge I SAC Unit Per Home If Multiple Homes Or Units-May Need To Pay Additional.SAC Charges ❑ *SAC Grandfathered In— Permit# bate of Permit Must have had Hook Up&Home ftior To-1anuary 1,I�73 *Refer to Helpful Hint Sheets,Or Ask IfNecessary *'If Multiple Units May Need To Pay Additional SAC!Charges ❑ *Comuoereial— Permit g Accounted For Date of>aermiit 'Letter From Met Council Showing Use-Or Additional Units Needed- *Contact Jodi at(651)602-1113 To Obtain Letter(Usually Building Official Obtains) *Copies Ta;Lyle,Street Ftle&One On C©py , Permit Far Reporting *If unable to determine,wilthave to wait to be issued until determination can be made ❑-SEPTIC Arca- WATCH FOR THESE CONNECTIONS Person Will Have To Pay Connection Fees&Assessments+SAC Charges Refer T'o Current Year Fee Schedule! Don't-Release Until Fees Are'P'AJD1 (Ash for,Scott ar bin's Help With These) Will Need Approval From Public Works(Scott) ❑ Special Grinder Pump Needed -,Have Them Talk To Scott For Qu ons 4 Pricing Give Them Special Hand Outsi(In Drawer;Vo ith SOW Permit) ❑ Permit Needs Approval From Public Works: ' Approved By. *Side note,Connection Permits-Cover Septic Tank AIMAm�tnent Also,Per Lyle 1 ✓' � GENERAL NOTES .. �, t. a�mm�rtu-nnew�r.rmorsmuuwmn. i \ LEGEND lid, \ mGma�B CWRg1Y O IL \2y .-.._._,ewe \l J P�lMtB VAtve f6V1 �y FFE(EXISTING)-' a t 1012.11 _error we- , � � � FFE(PROPOSED)n 101$.1 0 WMI 05 i 1 �Ry #11... P. !da W Zwa P. p. P* P6 116 p. W IP f- R. 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