HomeMy WebLinkAbout2010-01189 - sewer repair - CITY OF ORONO PERMIT NO.: 2010-01189
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 12/14/2010
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 550 ORONO ORCHARD RD S
PIN : 02-117-23-31-0006
LEGAL DESC : MINNETONKA BLUFFS
: LOT 000 BLOCK 013
PERMIT TYPE : SEWER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : REPAIR
NOTE: SEWER REPAIR
APPLICANT SEWER CONNECT/DISCONNECT/REPAIR 50.00
ELMER J. PETERSON COMPANY STATE SURCHARGE SEWER&WATER 5.00
5921 DAGUE AVE SE TOTAL 55.00
DELANO,MN 55328
OWNER
LARSON, SANDRA S
PO BOX 546
WAYZATA,MN 5539 1-
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
r ed at any tim for due cause. /
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Applicant rmitee Signature Date Issue•/I:y Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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Completed
2750 Kelley Parkway Tn House SAC Deteirmrlation Form
;p Crystal Bay,MN 55323
,, (952)249 4600 .Approved By(If Requirecd)
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 II O •MATIO
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.
TYPET4r4i4V111
❑Residential(May Require Approval) ❑Commercial(Approval Required)
❑ New Connection ❑Additional Connection ❑Re-Connection 1:1 Repairs ❑Disconnect
❑ Water Availability Connection For Future Hook-Up to Water
Job Site/Owner Information:,
Site Address: 6 0 C �-�es o (•c a
Owner:/<e4 T . Ly•5 Mailing Address:
City: Zip:
Home Phon05-) cC.25- 9 l S. Alternate Phone:
Contractor Information
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Contractor: J. Pe 7 t.Sa-i CO Contact Person: J= er�� G (41 4-74
Address: '° c, State License#: 21
City: p-c,fG- Zip?5921 Expiration Date:
Phone: 2(3)9 22 -2-cf Zct Alternate Phone: 6/Y Z g z -2 fa7, C- 1/
❑SAC Charge(2010 Rate=$2,100.00) $
(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 inches;material 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: $
2. STATE SURCHARGE $ 5.00
3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00
4. TOTAL PERMIT FEE(Add Lines 1-3 Above) $
AlDDTQNI W°AER #ETERS
• 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, and certifies that all statements made on this application are,true and correct.
Applican l � Date:aa-/6( /61