HomeMy WebLinkAbout2015-01044 - water meter I 1 1
• CITY OF ORONO I* 121I' I10 115I I-I 0 1 I'1 111
*
2750 KELLEY PARKWAY DATE ISSUED: 08/19/2015
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 450 OLD CRYSTAL BAY RD N
PIN : 33-118-23-13-0020
LEGAL DESC : CRYSTAL BAY BUSINESS CENTER 2ND ADD
: LOT 001 BLOCK 001
PERMIT TYPE : WATER METER-IRRIGATION
PROPERTY TYPE : COMMERCIAL-BUSINESS
CONSTRUCTION TYPE : WATER METER-IRRIGATION
NOTE: 1 IRRIGATION
SERIAL#70252684
ERT# 1813754838
WATER METER IRRIGATION HORN 1 WATER METER IRRIGATION 1
APPLICANT WATER METER IRRIGATION 926.92
WATER METER IRRIGATION HORN 116.30
NORTHERN MECHANICAL TOTAL 1,043.22
1975 SENECA RD
Payment(s)
EAGAN, MN 55122- CHECK 3544
1,043.22
(651)789-2275
OWNER
Jem Technical
450 OLD CRYSTAL BAY RD N
LONG LAKE,MN 55356-
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
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
requested in conformance with the State Building Code.This permit may be !„
revoked at any time for due cause.
elAfr-SL 3 19/
Applicant Permitee Signature Date pvIssued By Signature Date
08/17/2015 11 :57 #3778 P. 001/002
•
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Cityof Urono R CI y US':ONLY = 3 ��.,7 f,. C
�`°'V0 P.O.l5ox 66 Date Ricer yEll /S Permit ii p30/.J— t
2750 Kelley Parkway
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Crystal Bay,MN SS323 Approved By""'Required): 7 / 8// V5I
(952)249-4600 <`
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l�Krsrto�� CITY OF ORONO—WATER METER FORM LW'S°I Ti IS I IS
_�---• (Note:Some permits may require approval by the Building Official and/or Public Works Department)
GENERAL INFORMATION 4 ltd
11
1. WATER METERS must be picked up and paid for at City Hall, / 6 �l' /3 2 J
2. If possible,fax in this application ahead of time;we will then call you and let /ttIL"
the water meter in stock. Fax Number:(952)249-4616. Also,you can call ahe 70, , p2J
sure we received the fax,or to warn us that the fax is corning.
3. WATER METERS must be set and sealed by Orono Water Aepartm / Q //� [7/
upon completion of meter installation. // o / `
TYPE OF PERMIT
(Check All That Apply)
0 Residential(May Require Approval) Commercial(Approval Required)
rtiNew Meter 16 Additional Meter—For: r( r.54 4, 0 Replacement Meter
Job Site/Owner Information:
Site Address: 11Otc e ryrN grate RA 14
J
Owner: 4+.04 Tv...ea.% Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information_
Contractor: f`d ci4n mktwn t eaI Contact Person: 'Sa i n 442 yA sa,mi
ecR GK ivcs
Address: E 9 7c ateo- 2ec State License#: pc 6,4 -i&-s
City: ae...1o..w. Zip:`6 ag.Expiration Date: i-2-- t,i-
Phone: I- ' 1 7 1 - d-17,1-- Alternate Phone: ' = ‘?—t-g/Ia
\I_ -acne eft �v\ rad F«6^6,+r
WATER METERP RMT FEES1 ' ,
WILL' vJLULA D BY iT STAFF. , r.
❑ 5/8"METER- ❑ 3/4"METER- ❑ 1"METER-
El 5/8"HORN - 0 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) $ Q '
CITY-USE ONLY ,�
* For Current Pricing Refer to Current Year- Water Meter Pricing Chart * I l�g LV
CI V
BRAND:
f
SIZE: E] 5/8" ❑ 3/4" ❑ 1" Other 1 Z"
SERIAL#: 70 215 FfY
ERT HIGH#: 11111111111111111013 (if applicable)
1831754838
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 in strict accordance with the ordinances of the City and the regulations of the State
of Minnesota, andtir---
certifies hat all statements made on this application are,true and correct.
ty_ e_. ,---
Applicant: ti, Date: I 1/i
PP
Original: 1-Address File
Make Copies For: 1- Utility Billing Department
D af.\., .___ 6
DATE TIME
CITY OF•ORONO CALLED IN
INSPECTION NOTICE Nog SCHEDULED
OF/S v�
PERMIT NO. - COMPLETED
ADDRESS "5O 04Y 11 ✓` .• ,',.iik, % A/
OWNER TELEPHONE NO.
V '`�
CONTRACTOR / O A /1
�Q ) /� ern,
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DESCRIPTION
W ❑ FOOTING 0 DEMO-FINAL 0 SEPTIC FINAL
Q ❑ POURED WALL 0 PLUMBING RI 0 EXCAV/GRADING/FILLING
Q ❑ FOUNDATION WATERPROOF 0 PLUMBING FINAL 0 TREE REMOVAL
❑ RADON SLAB 0 MECHANICAL RI 0 SITE INSPECTION
Q 0 FRAMING 0 MECHANICAL FINAL 0 PROGRESS
❑ INSULATION 0 WOOD BURNER/FIREPLACE 0 COMPLAINT
Q 0 FINAL 0 WATER HOOK-UP 0 FOLLOW-UP
W 0 AS BUILT-SURVEY 0 SEWER HOOK-UP 0 HARD COVER REMOVAL
IQ_
❑ DEMO-SITE 0 SEPTIC IN ALL 0 FOUNDATION/REMOVAL
Z OWN ERICONTRACTOOiR TO MEET YOU:_YES /NO
SI COMMENTS:S P)� a(7 2t 5//iry4 '
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0
Cc Crt tal . /13 / '5 ' 738
0
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Lu• 0 WORK SATISFACTORY:PROCEED l [PROJECT COMPLETE
IX
0 CORRECT WORK&PROCEED ❑\ISSUE CERTIFICATE OF OCCUPANCY
IQ
CZ 0 CORRECT WORK,CALL FOR REINSPECTION TEMPORARY
C.1 BEFORE COVERING PERMANENT
❑CORRECT UNSAFE CONDITION WITHIN HOURS. ❑PHOTO TAKEN
INSPECTOR WILL RETURN ❑CITATION ISSUED
❑STOP ORDER POSTED.CALL INSPECTOR
❑INSPECTION REQUIRED.CALL TO ARRANGE ACCESS.
Call for the next inspection 24 hours in advance. (952) 249-4600
Owner/Contractor on site: ,�
Inspector. a Ci/i
White Copy/Inspector's File Canary Copy/Site Notice