HomeMy WebLinkAbout2011-00903 - water meter � , .
CITY OF ORONO PERMIT 1Y0.: 2011-00903
2750 KELLEY PARKWAY
ORONO, MN 55356- �ATE ISSUED: 08/22/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 2540 SANDSTONE LA
PIN : 33-118-23-11-0016
LEGAL DESC : STONEBAY '
: LOT 013 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
(1)3/4"NEPTUNE WATER METER
SERIAL#52155575
ERT# 1831447977
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 303.70
K& S PLUMBING LLC WATER METER RESIDENTIAL HORN 86.64
9572 KNOX AVE.N. TOTAL 390.34
BROOKLYN PARK,MN 55444-
(763)425-8760
Minnesota State License#: 065380-PM
OWNER
O.T. Development,LLC
10300 IOTH AVE.N.
PLYMOUTH, MN 55441-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according[o
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permi[is for oniy the work described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing[his type of work
shall be compied wi[h whether or no[specified herein.This permit will
expire and become null and void if construction authorized is not
commenced within I 80 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 usuring all required inspections are
requested i nformance with the State Building Code.This permit may be
revoked an time fo e c se.
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Applic t Permitee Signature Date Issu By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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CIT' USE ONLY
fO� � � City of Orono � �) �-j�(,�
gr`�0�� P.O.Box 66 Date Receiv �% '/ Permit# O�(�/l— (/ /
��� ,,�.,.,,,_ rI 2750 Kelley Parkway
S� ����. 1�� Crystal Bay,MN 55323 Approved By:(If Required):
�\����`,r�.�,�yy� (952)249-4600
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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. 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
i
Job Site/Owner Information:
Site Address: �`rU S�k'�'�S��Q Li✓
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
�u' �
Contractor: � �G Contact Person: � /'
Address: 1-� �� �� �✓��� State License #: �6�3��--�/► �
City: �� Y�Q2�[ Zip:sS��/ Expiration Date: .?� ��joL
Phone: �](�,���,�r�j�:S73`� Alternate Phone: �G� ����7(a P
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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 -
� "�VATER METER (THESE WILL HAVE TO BE SPECIAL ORDERED&PRICES DETERMINED)
l. METER FEE: $
2. HORN FEE $
3. TOTAL PERMIT FEE(Add Lines ]-2 Above) $
CITY-USE ONLY
* For Current Pricing Refer to Current Year- Water Meter Pricing Chart *
Bu�ND: / " 'e,� �[��I -�_
SIZE: ❑ 5/8" � 3/4" ❑ 1" ❑Other "
SERIAL#: �a l.�55 7�7�
ERT HIGH#: ����������������������������� (if applicable)
1831447977
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 er fies that all statements made on this application are,true and correct.
Applicant: Date: g /
Reset Form
O�•iginal: 1-Address File
Make Copies For: 1- Utiliry Billing Depa��tment 1-Cash Drawer