HomeMy WebLinkAbout2015-00613 - water meter f CITY OF ORONO * z 0 1 5 - 0 0 6 1 3 *
• 2750 KELLEY PARKWAY DATE ISSUED: OS/15/2015
ORONO, MN 55356-
� 952 249-4600 FAX: 952 249-4616
ADDRESS : 2496 SANDSTONE LA
PIN : 33-118-23-11-0023
LEGAL DESC : STONEBAY
: LOT 020 BLOCK 001
PERMIT TYPE : WATER METER-RESIDENTIAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER METER-RESIDENTIAL
NOTE: INSEPCTIONS ARE DONE BY PUBLIC WORKS DEPARTMENT.
TO SET-UP AN INSPECTION,PLEASE CALL:(952)249-4613
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 242.65
WATER METER RESIDENTIAL HORN 80.42
SCHULTIES PLUMBING TOTAL 323.07
1521 94TH LANE NE Payment(s)
BLAINE, MN 55449 CHECK 33287 314.67
(651)786-4007 CREDIT CARD 9407 8.40
Minnesota State License#:plbg-058799PM,mech-MB005379
OWNER
Wooddale Builders Inc.
6117 BLUE CREEK DR
SUITE 101
MINNETONKA,MN 55343-
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
expice 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.
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Applicant Permitee Signature Date Issued By Signature Date
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rr—_ , FOR CITY USE ONLY
�����l� City of Orono 5/r� � �7 G,( b ��( 3
i y � P.O.Box 66 Date Received: ermit# l� �
%` 2750 Kelley Parkway �-
Crystal Bay,MN 55323 Approved By:(If Required):
� (952)249-4600 � �� �
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.�,���H`���� CITY OF ORONO-WATER METER FORM
,...,��-- (Note:Some permits may require approval by the Building Official and/or Public Works Department)
GENERAL INFORMATION
I. WATER METERS must be picked up and paid for at City Hall.
2. Ifpossible,fax in this application ahead of time;we will then call you and let you know we have
the water meter in stock. FaY Number:(952)249-4616. Also,you can call ahead of time to make
sure we received the fax,or to warn us that the fax is coming.
3. WATER METERS must be set and sealed by Orono Water Department (952) 249-4600,
upon completion of ineter installation.
TYPE OF PERMIT
Check All That A 1
��Residential(May Require Approval) ❑Commercial(Approval Required)
�New Meter ❑Additional Meter—For: ❑Replacement Meter
Job Site/Owner Information:
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Site Address: �y��i�
Owner:�,c�-zrG���/`�L�/Cc��ailing Address: ����� ��������i"�(�L�
City: /����..L���G���� p: ��
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Home Phone: ��j� `��J ��U,jr� Alternate Phone: ���
Contractor Information:
, �
Contractor: � ��1Contact Person: � �
Address: �l ��� ,L�State License#: � `- l
City: ����'�-, Zip� Expiration Date: �� �j � �
Phone: �����6� -'��� Alternate Phone: �j� ��`'!�/�
� WATER METF� PERMIT�'�ES � �
WILL BE CAULUI�A'TEI7 BY GITY STAFF
0 5/8"METER- ❑ 3/4"METER- ❑ 1"METER-
� 5/8"HORN - ❑ 3/4"HORN - ❑ 1"HORN -
❑ "WATER METER (THESE WILL HAVE TO BE SPECIAL ORDERED&PR[CES DETERMINED)
� � � , cc�
1. METER FEE: $
2. HORN FEE $ ��/ ' T �
3. TOTAL PERM[T FEE(Add Lines 1-2 Above) $ � � =3 ' U �
CITY-USE ONLY
* For Current Pricing Refer to Current Year- Water Meter Pricing Chart *
BRAND: ����`�����'�"
SIZE: �] 5/8" ❑3/4" ❑ ]" ❑ Other "
SERIAL#: _ � � JZ�� �C�
ERT HIGH#: �����������������������U���� (if applicable)
185238g388
ADDITIONAL INFORMATION—WATER METERS
The undersigned hereby applies to the City of Orono far issuance of a water meter permit, agrees
to do all work in strict accordance with the ardinances of the City�and the regulations of the State
of Minnesota, and certifies that all statements made on this application are,true and correct.
Applicant: Date: � �
Original: 1-Address File
Make Copies For: I- Utility Billing Department
crr�r oF oRONo
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8ervtceOrderHumt� 824
, SERVICE ADDRE33 DUE DATE: � �
� f�9G S�i d ��riM�: � /`S
- .- - �'�v o �
CUSTOMER � BILLING HOME PHONE: �
81LLiNG WORK PHONE: A<
ACCOUNT NUMBER BOOKISTOP: 's:
:�� �,
DATFJTiME CREATED CALL TAKEN BY:
.. _ . _ .,�
R�awabd By:
NATURE OF WORK ORDER --
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Final Btlllnp A�ddross(lnfo);Forwarding Adc[rs�s New Customer Informatlon:
Addtess:
Name:
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��' Mailing Addreas:
State: -
Zip: �.__�. _..._....__._.._ _..___._._.---------.-.._.__�.__
Phone:
READING INFORMATION Sarvios Nurnber: 10�Water 7A■Deduct AAtr
CURRENT METER _S�E �K� SERIAL NUMBER LAST REAp1NCi DATE
$ervl'x kumb�r Da�e Installed: ERT ID �T�p�ER READING
10 �--
�8�� 38�3�g �
CURRENT READING
METER REMOVED s� NEPTUNE � S�A�NUMBER CURRENT READING
� S�n�ice Numbsr. � �..
10 � InVentory ,
❑ ��� � G��z�.��q i
�
METER INSTALLED $� M�� i SERIAL NUMBER NEW STARTING READ
I
8�Mcs Numbor. �� Date Idstalled: � ERT ID �d V�C�C�
✓
❑ Deduct Meter � -��"
RElM�RKB: S.�� n��S
r�
Dats Compl�d: �a����SIONED� �"� _ __ �PdSte S/0
� ❑ Update Inquiry
���i �� DATE TIM�
"�CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED '
PERMIT NO. � COMPLEfED
ADDRESS
OWNER TELEPHONE NO. �?�l7 I
CONTRACTOR `e �
,
� DESCRIPTION �L u-h'!�U / /�1� O
W ❑ FOOTING ❑ DEM -FINA� ❑ SEPTIC FINAL
Q ❑ POURED WALL ❑ P MBING RI ❑ EXCAV/GRADING/FILLING
� ❑ FOUNDATION WATERPROOF PLUMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ PROGRESS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
W ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ HARD COVER REMOVAL
� ❑ DEMO-SITE '❑�TIC INSTALL ❑ FOUNDATION/REMOVAL
2 OWNERICONTRACTOR TO MEET YOU: YES_NO
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v�i COMMENTS:
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W ❑WORKSATISFACTORY:PROCEED PROJECT COMPLEfE
� ❑CORRECT WORK&PROCEED ❑ IS UE CERTIFICATE OF OCCUPANCY
W
O ❑CORRECT WORK,CALI FOR REINSPECTION TEMPORARY
V BEFORECWERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑ pHOTO TAKEN
�NSPECTOR WILL REfURN
O STOP ORDER POSTED.CALL INSPECTOR O CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Ca11 for the next inspection 2a hours i art dy�ra . 2) 249-46�0
OwnerlContractor on site:
Inspector.
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White Copylinspector's Flle Canary CopylSite Notice