HomeMy WebLinkAbout2017-00377 - water meter t �
CITY OF ORONO * z 0 1 7 - 0 0 3 1 1 *
2750 KELLEY PARKWAY DATE ISSUED: 04/03/2017
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2800 SHADYWOOD RD
p�� : 21-117-23-13-0023
LEGAL DESC : REG. LAND SURVEY NO. 1196
: LOT 000 BLOCK 000
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
1"NEPTUNE WATER METER
ERH#1541506626
SERIAL 52648030
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 372.06
WATER METER RESIDENTIAL HORN 144.64
COX PLUMBING LLC TOTAL 516.70
17041 172ND AVE SE Payment(s)
BIG LAKE, MN 55309- CHECK 6446 516.70
(612)242-9247
Minnesota State License#: plbg-PC644119
OWNER
BERGH, HANS&SHARON
2800 SHADYWOOD RD
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 Ciry 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 I80 days of the date of issuance,or if construction is
suspended for a period of l80 days at any time afrer 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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Applica Permitee Signature Date Issued By gnature Date
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FO�Y USE OiVLY
O City of Orono � �/' z� /�
�- �O P.O.Box 66 IIate Reeeiv�� Perrnit# �/,�/�7— v `
2750 Kelley Parkway
Crystal Bay,MN 55323 Approved By:(Ifiiequired):
(952)249-4600
��`�kEs o�``G� CITY OF ORONO-WATER METER FORM
H (Note:Some perm�ts may require approval by the Building Official and/or Public Works Department)
GENERAL INFORMATION
1. WATER METERS must be picked up and paid for at City Hall.
2. If possible, fax in this application ahead of time;we will then call you and let you lrnow we have
the water meter in stock. Fax 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 PERI�IT'T'
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�Residential(May Require Approval) ❑ Commercial(Approval Required)
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�.New Meter ❑Additional Meter—For: ❑ Replacement Meter
Job Site/Owner Info�nation:
Site Address: ��C� ��„��, t, �,�� �
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Owner:�2.�cr,�1-�-�6� c-S'�' ��'%� Mailing Address: �,j��S (vS ��/!�
c��y: l�'l�-,�/�P ��r�,�e z�p: ��s�%l
Home Phone: `7� �-�5� � .���U Alternate Phone:
Contra�tor Iriformation:
Contractor: 1 �, (�LC Contact Person: �Gf� C.d�
Address: �4y1 ��,,?�J,�.-� .�� State License #: A�l1�����i�/"7y
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City: ".� H' Zip: ��, Expiration Date: _f�- .�/ -- ��
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Phone: �-��� Alternate Phone: ��� -���--���
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WATE�t METE�.PE�MIT FEES
WILL BE CAULULATED BX CIT� STAFF
❑ 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&PRICES DETERMINED)
1. METER FEE: $
2. HORN FEE $
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) $
CITY-USE ONLY
* For Current Pricing Refer to Current Year- Water Meter Pricing Chart *
BRAND: 1'V C���{��-- i
Other " 52648030
SIZE: ❑ 5/8" ❑ 3/4" �f � IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII
SERIAL#: � S.`7`� �� ��O Z�' L��
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� �i� �( �Q j�1 �S�r�al unimnnmiinnmimi �licable ��
ERT HIGH#: � � 1541506626 )
ADDITIONAL INFORMATION—WATER METERS
The undersigned hereby applies to the City of Orono for issuance of a water meter permit, agrees
to do al] 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 conect.
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Applicant:
� Date: '��'� I�_
Original: 1-Address File
Make Copies For: 1- Utility Billing Department
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DATE TIME
CITY OF ORONO CALLED IN
qd8PEC110N NOTICE SCHEDULED �'.� ��
PERMR NO. -��� COMPLETED
ADDRESS � �
OMINER TELEPHONE NO. � 7
coKTRac�roR 6�
� DESCRIPTION �"�
�y ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
� ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
O ❑ FOUNDATION WATERPROOF ❑ PLUMBIN(i FINAL ❑TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
� ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS
� ❑ INSULATION ❑WOOD BURNER/FIREPLACE ❑ COMPLAINT
� � FINAL ❑WATER HOOK-UP ❑ FOLLOW-UP
_ ❑AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
v ❑ DEMO-SfTE ❑ SEPTIC INSTALL
Z Oi1NN�lfTRACTOR TO MEEf 1fdU:_1f68 NO
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W O WORKSATISFACTORY:PROCEED ❑PROJECT(�MPLETE
� ❑CORRECT WORK 3 PFiOCEED ❑ISSUE CERTIFlCATE OF OCCUPWNCY
W
O O OORRECT YMORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECGVEF�NO PERMANENT
❑(�RRECTUNSAFECONDITIONWITHIN HOURS. p pHpTOTAKEN
INSPECTOR WILL RENRN
❑8TOP ORDER P08TED.CAIL INSPECTOR ❑qTATION ISSUED
❑INSPEC710N REQUIRED.CALL TO AF#iAN(3E ACCESS.
caa r�u�����no��,��os. (952) 249-4600
on site:
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