HomeMy WebLinkAbout2013-00927 - water meter _ CITY OF ORONO * 2 P1 1 3 - 0 P1 9 Z 7 *
� 2750 KELLEY PARKWAY nA'rE ISSU��: 09/10/2013
� ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 80 CREEK RIDGE PASS
PIN : 03-117-23-12-OO18
LEGAL DESC : CREEKSIDE [N ORONO
: LOT 007 BLOCK 001
PERMIT TYPE : WATER METER-RESIDENTIAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPF. : WATER METER- RESIDENTIAL
NOTG: [NSFPCTIONS ARE DONG BY PUBLIC WORKS DF?PARTMENT.
TO SGT-UP AN INSPECTION,PLEASE CALL:(952)249-4613
WATER METER RESIDENTIAL HORN I WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 392.92
TIGER HEATING& AIR WATER METER RESIDENTIAL HORN 104.45
12100 SINGLETREE LN
EDEN PRAIRIE, MN 55346- TOTAL 497.37
(952)448-4769 PAID WITH CC# 9015
Minnesota State License#: PC 643398
OWNER
Hometime Video Publishing Inc
4355 PEAVY RD
CHASKA, MN 55318-
AGREEMENT AND SWORN STATEMENT
The�cork for which this permit is issued shall be performcd according to
the approved plans and speciYications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
no[grant permission for additional or related work which requires separa[e
permits. All provisions of laws and ordinances goveming this type of work
shall be compied with whether or no[specitied 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
reques[ed in conformance with thc State Building Code.This permit may be
revoked at any[ime for due eause.
� � � / �/ / / /
Applicant Permitee ig re Date Issued y Si ture Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER T AN DESCR[BED ABOVE.
� .
FOR CITY USE ONLY
��� City of Orono
P.O.Bor 66 Date Received: Permit#
� 2750 Kelley Parkway
Crystal Bay,MN 55323 Approved By:(If Required):
(9�2)249-4600
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� ��,�' CITY OF ORONO—WATER METER FORM
�kESH� (*Note:Some permits 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 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 A pl )
d Residential (May Require Approval) ❑ Commercial(Approval Required)
��New Meter ❑ Additional Meter—For: ❑ Replacement Meter
,
Job Site/ Owner Information:
Site Address: U o l� rPG' � f�-��jP ,9� 5 S
Owner:�U✓Vle��'Y!� V iCYP� Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
/", �
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Contractor: � I er U�vl V1�J Contact Person:
/
Address: � ��� S� n��G �Pe Ln State License #:
City: �CVI l"c1��L Zip:SS Expiration Date:
Phone: �;."�L c���L S 7 y� Alternate Phone: �5 Z 2�? Z ZS3
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WATER METER PERMIT FEES
- WILL BE CAULULATED BY CITY 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)
l. 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: �C���
SIZE: ❑ 5/8" ❑ 3/4" [� 1" ❑ Other "
SEtuAL#: III III IIII II III II IIII I Ii II III
1834349779
ERT HIGH#: (if applicable)
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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.
� /' 9- i�,- ,3
Applicant: ✓ Date:
Origina[.• 1-Address File
Make Copies For: 1- Utiliry Billing Department I-Cash Drawer
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C/.�� ' DATE IME
�
CITY OF ORONO CALLED IN
INSPECTION N+Q�I E � SCHEDULED
PERMIT NO. G COMPLETED �/,�
ADDRESS `� � 4r-�
OWNER NO. D
CONTRACTOR �� �c.f�—�
� DESCRIPTION ��-u� c���,�
l� ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINALN/���'�
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADI �G/FILLI G
Q ❑ FOUNDATION WATERPROOF ❑ PLUMBING FINAL ❑ TREE REMOVAL
Z ❑ RADON SLAB ❑ MECHANICAL RI ❑ SITE INSPECTION
Q ❑ FRAMING ❑ MECHANICAL FINAL ❑ RATED WALLS
� ❑ INSULATION ❑ WOOD BURNER/FIREPLACE ❑ COMPLAINT
Q ❑ FINAL ❑ WATER HOOK-UP ❑ FOLLOW-UP
W ❑ AS BUILT-SURV ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
_
J ❑ DEMO- /►�Os PTIC INSTALL
� OWNERlCO RA TOR MEET YO�YES_NO
c�., COMME .
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W ❑WORKSATISFACTORY:PROCEED ❑ PROJECT COMPLEfE
� ❑CORRECT WORK&PROCEED ❑ISSUE CERTIFICATE OF OCCUPANCY
W
O ❑CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
V BEFORECOVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑ PHOTOTAKEN
INSPECTOR WILL REfURN
❑STOP ORDER POSTED.CALI INSPECTOR �CITATION ISSUED
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Ca11 for the next inspection 24 hours in advance. (952) 249-4600
OwnerlContractor on site:
Inspector. - a-�'�
White Copyllnspector's Ffle Canary CopylSite Notice