HomeMy WebLinkAbout2014-00889 (water meter) CITY OF ORONO * 2 0 1 4 — PJ PJ 8 8 9 *
`� � n`� 2750 KELLEY PARKWAY DATE ISSUED: 08/13/2014
, t� ORONO, MN 55356-
S� -=>2to2 —j (952) 249-4600 FAX: (952) 249-4616
ADDRESS : 262�'CASCADE LA
P1N : 33-l 18-23-1]-O l l,yt��
LEGAL DF,SC : STONEBAY FIFTH ADDITION
: LOT 004 BLOCK 001
PERMIT TYPE : WATER METER- RESIDENTIAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTIOIV TYPE : WATER METER- RESIDENTIAL
NOTE: [NSEPCT[ONS nRE DONE f�Y PUBLIC WORKS DEPARTMENT.
I'O SET-UP AN INSPGCT[ON,PLEASF,CALL:(952)249-4613
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL l
APPLICANT WATER ME"TER RESIDEN"I'IAL 245.70
WATER METER RESIDENT[AL HORN 68.97
PRECISION PLUMBING& HEAI�H[NG INC. TOTAL 314.67
4124 MACKENZIE CT
ST. MICHEAL, MN 55376 Payment(s)
(763)497-7486 CREDIT CARD 9766 314.67
Minnesota State License#:plbg-PC643806,mech-MB004099
OWNER
BUILDERS LLC, STONEBAY
14870 BROCKTON LANE
PLYMOUTH, MN 55446-
AGREEMENT AND SWORN STATEMENT
The Nrork for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and thc
State Building Codc. "1'his permit is ior only the work described and does
not grant permission for additional or related work which requires separatc
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 ot�issuance,or if construction is
suspended for a period of 180 days at any timc after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Codc."�his permit may be
revoked at any time for due cause.
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App er ee Signatuce.--� Date [ssued E3y Sig a rc Date
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' FOR CITY USE ONLY
���� City of Orono
P.O.Box 66 Date Received: Permit#
2750 Kelley Parkway
Crystal Bay,MN 553?3 Approved By:(If Required):
(9�2)249-4600
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�qK�SHo��� CITY OF ORONO-WATER METER FORM
(*Note:Some permits may require approval by the Building Official and/or Public Works Department
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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 know 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 PERMIT
(Check All That Apply)
❑ Residential (May Require Approval) ❑ Commercial(Approval Required)
❑ New Meter ❑Additional Meter—For: ❑ Replacement Meter
Job Site / Owner Information:
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Site Address: - ��� ���
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Owner: (��1 ��J�� Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
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Contractor: � � � ��- Contact Person: L� `' `r K�' � /�--
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Address: ���� ����- ��f���• State License #: (��(��������
City: ��� � � Zip:r1��(�,Expiration Date:
Phone: ���'���'(� -���� Alternate Phone: ��� � �����I �- ���(.�
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WATER METER PERMIT FEES
WILL BE CAULULATED BY CITY STAFF
� /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
* Far Current Pricing Refer to Current Year - Water Meter Pricing Chart *
BRAND: ��� .
SIZE: �5/8" ❑ 3/4" ❑ 1" ❑ Other "
SERIAL#: IIIIIIIIIIIIIIIIIIIIIIIIIIIII �j�� �j�3�
1850445035
ERT HIGH#: (if applicable)
ADDITIONAL 1NFORMATION—WATER METERS
The undersigned hereby applies to the City of Orono for issuance of a water meter 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.
Applicant: � � Date: � ���` � L"�
Original: 1-Address File
Make Copies For: 1- Utility Billing Department 1-Cash Drawer