HomeMy WebLinkAbout2016-01405 - water meter ,, . CITY OF ORONO * Z 0 1 6 - 0 1 4 0�
2750 KELLEY PARKWAY DATE ISSUED: 11/07/2016
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1885 CONCORDIA ST
PIN : 17-117-23-23-0002
LEGAL DESC : COFFEES ADDN TO SHADY WOOD LAK
: LOT 000 BLOCK 000
PERMIT TYPE : WATER METER-RESIDENTIAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER METER-RESIDENTIAL
NOTG: INSEPCTIONS AI2�DONE BY PUBLIC WORKS DEPARTMENT.
TO SET-UP AN [NSPECTION,PLEASF,CALL:(952)249-4613
I" WATER METER
SER[AL#53591581
GRT HIGH# 1541626820
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 372.06
WATER METEFZ RESIDENTIAL HORN 144.64
FREEDOM MECHANICAL TOTAL 516.70
8382 172ND AVE SE Payment(s)
BECKER,MN 55308- CREDIT CARD 6627 516.70
(612)363-6190
Minnesota State License#: mech-004042PM,plbg-PC642836
OWNER
KAISER, BERNARD&CAROLYN
2855 PROVIDENCE PLACE
INDEPENDENCE, MN 55359-
AGREEMENT AND SWORN STATEMENT
The work for which this pernii[is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and Ihc
State E3uilding Code. This permit is for only the work dcscribed and docs
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing Ihis type of work
shail bc compied widi whether or not specified herein.This permit will
expire and becomc null and��oid iY construction audiorized is not
commenced within l KO 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
rcquested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
L� �`,KJ �� 7 r � � l l��V
Applicant Permitee Signature ate Issucd Signature Date
F R Y USE ONLY
�O . ` City of Orono JI �
1�O P.O.Box 66 Date Receiv :� Permit#��6'' /
2750 Kelley Parkway
Crystal Bay,MN 55323 Approved By:(If Requiredj:
(952)249-4600
�F`-skF o��.�'� CITY OF ORONO—WATER METER FORM
SH
(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 far 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 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: � O �� ��� c\���
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Owner: �� 5-�r Mailing Address: v2 i� ��� ���e�'-'�-'�-�1� _
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City: -�-�� ,c,�n c��-v� •c.. Zip: J��$`�'
Home Phone: Alternate Phone:
Contractor Information:
Contractor: ��etc�sv� i'I+�c��,Hhi� ,ContactPerson: �„�{-�..
Address: 8 3 �� ���'��'�i�t State License #: � M�\ � i�% �.;���
City: �c�-K�� Zip::.�53c�3 Expiration Date: �e c_. :�.c��,
Phone: ���" ���3� � ��a Alternate Phone: � �0 � �� 3 " 3� ��
.
WATER METER PERMIT �EES
' WILL BE CAULULATED BY CITY STAFF
❑ 5/8"METER- ❑ 3/4"METER- ' METER-
❑ 5/8"HORN - ❑ 3/4"HORN - ' HORN -
� "WATER METER (THESE WILL HAVE TO BE SPECIAL ORD ED&PRICES DETERMINED)
1. METER FEE: $ � / 2 � D�
$ ( �-�-E- . (o �
2. HORN FEE
3. TOTAL PERMIT FEE(Add Lines 1-2 Above)
$ � 1 � .�7 (�
CITY-USE ONLY
* For Current Pricing Refer to Current Year - Water Meter Pricing Chart *
BRAND: �— y� e�
ED2F11 RDG3 �
SIZE: ❑ 5/8" ❑ 3/4" � 1" ❑ Other " � 53591581
SE�AL#: IIIIIIIIIIIIIIIIIIII�IIIII II IIIIIIIIIIII III
ERT HIGH#: (if applicable)
ui iiuum u ni i unm i ui
�541626820
ADDITiONAL INFORMATION-WATER METERS
The undersigned hereby applies to the City of Orono for issuance of a water meter permit, agrees
to do all work ir. 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: �
Original: 1-Address File
Make Copies For: 1- Utility Bil/ing Department
!
�� � � �" ��- �
�� DATE TIME
CITY OF ORONO CALLED IN
INSPECTION NOTICE SCHEDULED �7 J'�
PERMIT NO. .-���.(���COMPLETED
ADDRESS l �S�� c� �TL7 �C��r'� �
OWNER TELEPHONE NO. ��a ���� �`/�7
CONTRACTOR ,—���1 ��'Y� �� �`-E--�`--"
� DESCRIPTION � �� � �G�.�
ly ❑ FOOTING ❑ DEMO-FINAL ❑ SEPTIC FINAL
Q ❑ POURED WALL ❑ PLUMBING RI ❑ EXCAV/GRADING/FILLING
O ❑ FOUNDATION WATERPROOF�LUMBING 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
�U ❑ AS BUILT-SURVEY ❑ SEWER HOOK-UP ❑ FOUNDATION/REMOVAL
_
v ❑ DEMO-SITE ❑ S TIC INSTALL
2 OWNERICONTRACTOR TO M _NO
y COMMENTS:
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W� �WORKSATISFACTORY:PROCEED PROJECT COMPLEfE
W ❑CORRECT WORK 3 PROCEED ❑ ISSUE CERTIFICATE OF OCCUPANCY
0 ❑CORRECTVYORK,CALL FOR REINSPECTION TEMPORARY
V BEFORE COVERING PERMANENT
❑CORRECTUNSAFECONDITIONWITHIN HOURS. ❑pHOTOTAKEN
INSPECTOR WiLL RETURN
❑STOP ORDER POSTED.CALL INSPECTOR �CITATION ISSUED
❑INSPECTION REW IRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952 j 249-46�0
OwnerlContractor on site:
Inspector. �
-- �
White Copyflnspector's File Canary CopylSFte Notke