HomeMy WebLinkAbout2008-00398 - water meter CITY OF ORONO PERMIT NO.: 2008-00398
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 1 U19/2008
° ' 952 249-4600 FAX: 952 249-4616
ADDRESS : 2118 SHADYWOOD RD
PIN : 17-117-23-42-0016
LEGAL DESC : WILEYS PARK LAKE MTKA
: LOT 000 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
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 382.70
LAKE SIDE PLUMB&HEATING INC. VVATER METER RESIDENTIAL HORN 95.00
12469 ZINRAN AVE S
SAVAGE,MN 55378 TOTAL 477.70
(952)8947600
Minnesota State License#:060769
OWNER
HANSSEN,PAUL&LEANN
2118 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 specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not grant pertnission 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 applicant is responsible for assuring all required inspections are
�equested in conformance with the State Building Code.This permit may be
revoked at any time for due cause. /4/�_��
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Applicant Permitee Signature Date Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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FOR CITY USE ONLY
�a�� City of Orono ��J� � C'
��� ��� P.O.Box 66 DaTe Received: � � � Permit# ��� ��
� �ti�� ;� 2750 Kelley Parkway �
,�� ���`,� �_ �i, Crystal Bay,MN 55323 Approved By:(If Required):
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Y��o� (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
Job Site/Owner Information:
Site Address: � ( I g s t�A� ;'�LJ�p,� ��
Owner: Mailing Address:
City: 0(t.o�G Zip:
Hame Phone: Alternate Phone:
Contractor Information:
Contractor: LA��S���" P�ur�1g/n)� Contact Person: Uf�✓i�
Address: 1•Z46�! Z/n%�o4N �✓E State License #: ��,�76� �Y�1
�3 7$
City: ��1✓AGE Zip: Expiration Date: CL 3( ���
Phone: �5�-`�`�"l -76G� Alternate Phone:
� � 1
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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 -
❑ "WATER METER (THESE WILL HAVE TO BE SPECIAL ORDERED&PRICES DETERMINED)
1. METER FEE: $ � [� � � ��
2. HORN FEE $ % � � �
3. TOTAL PERMIT FEE(Add Lines l-2 Above) $ �- �, ��
CITY-USE ONLY
* For Current Pricing Refer to Current Year- Water Meter Pricing Chart *
BRAND: ���-��������
SIZE: ❑ 5/8" ❑3/4" � 1" ❑Other "
sExiaL#: ,� �1 ��? �� �)C_�
III III IIIII II II IIII II III I Illi
ERT HIGH#: 1810052916 (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 wark in strict accordance with the ordinances of the City and the regulations of the State
of Minnesota, and certi s that all state nts made on this applicarion are,true and correct.
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Applicant: \ Date: 1 � �� U �
Reset Form
Original.• 1-Address File
Make Copies For: 1- Utility Billing Department 1-Cash Drawer