HomeMy WebLinkAbout2015-01047 - water meter • CITY OF ORONO ��
2750 KELLEY PARKWAY * z 0 1 5 - 0 1 0 4 7 *
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DATE ISSUED: 08/18/2015
� ORONO, MN 55356-
(952 249-4600 FAX: (952 249-4616
ADDRESS : 2477 SHADYWOOD RD
PIN : 20-117-23-11-0027
LEGAL DESC : REG.LAND SURVEY NO.0088
: LOT 000 BLOCK 000
PERMIT TYPE : WATER METER-RELIGIOUS
PROPERTY TYPE : RELIGIOUS
CONSTRUCTION TYPE : WATER METER-RELIGIOUS
NOTE: ERT#1540059016
SERIAL#53415947
NEPTLINE,E-CODER R900I
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 294.42
WATER METER RESIDENTIAL HORN 80.42
BERGSTROM PLUMBING TOTAL 374.84
26020 104TH STREET Payment(s)
ZIMMERMAN,MN 55398 CHECK 5129 374.84
(763)856-9898
OWNER
Int'1 Ministerial Fellowship
1109 MOORE LAKE DRIVE NE
FRIDLEY,MN 55432-
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 [he
State Building Code. This permit is for only the work described and does
not grant permission for additional or related work which cequires 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 aze
requested in conformance with the State Building Code.This permit may be ,{��
revoked at any time for due cause. �
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A ic t e ' e � ture a e Issued By Signature Date
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� FOR CTI'Y USE ONLY
City of Orono
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� �O P.O.Box 66 Date Received:�?�J�rmit# �--��S
2750 Kelley Parkway
Crystal Bay,MN 55323 Approved By:(IfRequired): n
(952)249-4600 ' ��
���q RF.�'� CITY OF ORONO —WATER METER FORM ( ��
kESH� (Note:Some permits may require approval by the Building Official and/or Public Works Departmel�
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: Z`�'��l SFj��`I�^-���"�� L�� �xt-��.S��'�',`�.+�t�.� ���-�'�
Owner: ��N Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
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Contractor: ���v�"l �-�t�l�� Contact Person: .Fc�k'
Address: 2�� 1���� � State License #: �►"�1 E7�� :Z-7
City: �i►+�M�l�-wl.�� Zip: ��j`�8 Expiration Date: �4= I ��'
Phone: ���3-��� •�S9f� Alternate Phone: ��� � ��� �d��='
.
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 1-2 Above) $
CITY-USE ONLY
* For Current Pricing Refer to Current Year - Water Meter Pricing Chart *
BRAND: � '1;�-�Q.. sia
53415947
SIZE: ❑ 5/8" 3/4" ❑ l" ❑ Other " I II I II III IIII II I I II II III I(`
��" ' AL#: �
` SERI
�"�� ERT HIGH#: t ✓� O ' S l �� �__ (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.
, •
Applican .� Date: / ��
Original: 1-Address File
Make Copies For: 1- Utility Billing Department