HomeMy WebLinkAbout2009-00701 - water meter i • �
CITY OF ORONO PERMIT NO.: 2009-00701
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE [ssuEn: 10/13/2009
952 249-4600 FAX: 952 249-4616
ADDRESS : 2100 SHADYWOOD RD
PIN : 17-117-23-31-0041
LEGAL DESC : WILEYS PARK LAKE MTKA
: LOT 030 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
NEPTUNE WATER M� MET'EJZ,
5/8"-SERIAL#86055548, ERT HIGH# 1820836491
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 268.05
HUNTS PLUMBING INC WATER METER RESIDENTIAL HORN 66.83
15225 CARROUSEL WAY#1 TOTAL 334.88
ROSEMOUNT, MN 55068-
(651)322-1130
Minnesota State License#: 58964
OWNER
MARHULA, DAREN
2100 SHADYWOOD RD
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specitications,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 goveming 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 ap licant is responsible for assuring all required inspections are
req� d in conformance with the State Building Code.This permit may be
re�o ed at an t e�'r due,�a'use.
y� �•U/ �/U��`�� i l.� i �j /�i /.�i �
Applicant Permitee Signature Date �
Is� d By �gnature Date
SEPARATE PERMITS REQUIRED FOR WORK THER THAN DESCRIBED ABOVE.
n
J �
FOR CITY USE ONLY
O¢p�O City of Orono /� G � �
P.O.Box 66 Date Received: _�;��"�-f- Permit# (�DU%' D
. 2750 Kelley Parkway
� �'�'• Crystal Bay,MN 55323 Approved By:(If Required):
'a �'� ; o� (952)249-4600
�ttaHo6�
CITY OF ORONO—WATER METER FORM
(*Note:Some permits may require approval by the Building Official and/or Public Works Deparhnent')
GENERAL INFORMATION
1. WATER METERS must be picked up and paid for at City Hall.
2. If possible,faac in this application ahead of time;we will then call you and let you know we have
the water meter in stock. Faac Number:(952)249-4616. Also,you can cail ahead of time to make
sure we received the fa�c,or to warn us that the fau 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:
Site Address: �-( �� S�a�.V � I�.
Owner:�Oi,V'�vt ��,r�,a,�a . Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor: �U /' c,c,,wdt ` C. Contact Person: `�*�
Address: <s2?s,�' �t�xSf.t I�a�l. ,�t��'� State License#: Sg q�2� —" ��
City: � 'Gµ0 uJ �7 Zip: SS 6 b� Expiration Date: �Z 3l l�
Phone: �5��-�z2 - 1 i 3� Alternate Phone:
s `,
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)
1. METERFEE: $ ��P g'� S
2. HORN FEE $ V� �- � 3
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) $ �3 �� � �
CITY-USE ONLY
* For Current Pricing Refer to Cunent Year- Water Meter Pricing Chart *
B�ND: ��.� -{-t�V1 �
SIZE: �5/8" ❑3/4" ❑ 1" ❑Other "
SERIAL#: o �p v S S 5 �- �
ERT HIGH#: III III II'I82I�I8I3IIGI4I91IIII II (�f 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• �;—.�_�e���%'C.l�z� Date: �o -- l'3 �0 7�'
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