HomeMy WebLinkAbout2011-00117 - water meter . CITY OF ORONO PERMIT NO.: 2o�i-oo���
` - 2750 KELLEY PARKWAY
ORONO,MN 55356- DATE ISSUED: 02/22/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 669 SANDSTONE CIR
PIN : 33-118-23-11-0038
LEGAL DESC : STONEBAY
: LOT 035 BLOCK 001
PERMIT TYPE : WATER METER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER METER
NOTE: INSEPCTIONS ARE DONE BY PUBLIC WORKS DEPARTMENT.
TO SET-UP AN INSPECTION,PLEASE CALL:(952)249-4613
REPLACEMENT 5/8"WATER METER-ORIGINAL METER FROZE AND BROKE
SERIAL#89835183 ERT HIGH 1831403225
WATER METER RESIDENTIAL HORN 0 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 234.22
THOEN PLUMBING SERVICE, INC. WATER METER RESIDENTIAL HORN 0.00
14980 MAPLEWOOD LANE
COLOGNE,MN 55422- MISC FEE 0.00
(952)944-5399 TOTAL 234.22
OWNER
O.T. Development,LLC
LLC,O.T. DEVELOPMENT,
2670 KELLEY PKWY
ORONO,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 sepazate
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 l80 days at any time after work has commenced.
The applicant is responsible for assurin equired inspections aze
requested in conformance with th e Building Code.This permit may be
revoke any ti e for due se. ' I �
`-ta`Z�i �
Applicant ' e Signature Date I y igna ure Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
1 �
�3 �.��
FOR Y SE ONLY
p City of Orono /J � �J
4 � P.O.Box 66 Date Received: /�ertnit# �G// U(/� /
�yy,,�,,,�, � 2750 Kelley Parkway
� ``���'' r Crystal Bay,MN 55323 Approved By:(If Required):
����o�,�i. (952)249-4600
0
CITY OF ORONO—WATER METER FORM
(*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. I�ossible,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: �eplacement Meter
Job Site/Owner Information:
Site Address: � /�� � �
Owner: �'��i� Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
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Contractor: C ntact Person: �
Address: ��lJ����yhh�P ��' State License#: C f .�/LtJ — P^-�
City: � Zip:� Expiration Date: ,�2�3�� ��/Z
Phone: r����'I/rZ� Alternate Phone:
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�S/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 *
Bx�,r�: JV-� ��'-I�IVv�--
SIZE: �5/8" ❑3/4" ❑ 1" ❑Other "
SERIAL#: g`l 8�5 1 03
ERT HIGH#: �������������������� (if applicable)
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,and certifies that all statements made on this application are,true and correct.
Applicant: Date: Z' Z 2 � �
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Original: 1-Address File
Make Copies For.• I- Utiliry Billing Deparhnent 1-Cash Drawer