HomeMy WebLinkAbout2009-00046 - water meter � ; , CITY OF ORONO PERMIT NO.: 200�-00046
2750 KELLEY PARKWAY
ORONO,MN 55356- DATE ISSUED: 02/10/2009
952 249-4600 FAX: 952 249-4616
ADDRESS : 2680 SHADYWOOD RD
PIN : 21-117-23-24-0046
LEGAL DESC : SHORE HILLS
: LOT O15 BLOCK 000
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
NEPTLTNE- 1" WATER METER-SERIAL#49857806-ERT# 1810050396
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 394.67
WESTONKA MECHANICAL INC WATER METER RESIDENTIAL HORN 104.45
6501 COLJNTY RD 15
MOiJND,MN 55364 TOTAL 499.12
(952)472-4966
OWNER
SEWALL,BARRY
2680 SHADYWOOD RD
EXCELSIOR,MN 55331-
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 dces
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 wikh whe[her 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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Applicant ermitee Signature Date s ed By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
� . . .
�'U�t CT3'Y US�U1�1LY
O,¢p�O City of Orono ,�j � a��p
P.O.Box 66 Date I�ceeiucFd;?'+�� • Asrmit# J�,�
2750 Kelley Parkway
� ;. ., � Crystal Bay,MN 55323 Appraved By:(if lt�quireti): -
�� (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 Deparhnent*)
GENEI�AL�1FQRIVIATIt�N '
1. WATER METERS must be picked up and paid for at City Hall.
2. If possible,fax in this applicarion 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 C�F;P�I�I�iIT
Cheek A11 That A 1
❑Residential(May Require Approval) ❑Commercial(Approval Required)
�] New Meter ❑Additional Meter—For: ❑Replacement Meter
Job Site/Uwzier Information:
Site Address: � L �'o ��Q�yc�.�a� C`� ��
Owner: Mailing Address:
City: d r o h o Zip:
Home Phone: Alternate Phone:
�ontractor�c��nation:
w�s'foh ►�50. me c
Contractor: C��+� ��'� Contact Person: ���k ar e1 nrbr r�sd�.
Address: ��'� C"r� �� f S State License#:
City: �o u�d Zip:SS31d-/ Expiration Date:
Phone: �l SZ-��z� 4 qs Q Alternate Phone: (ol��Zo�- 2 8 9 2-
. , �
❑ 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: N�T(�c!� �
SIZE: ❑ 5/8" ❑3/4" " ❑Other "
SERIAL#: Y-���5` O ��
III III IIII I II II AI I Ilul I Illi
ERT HIGH#: i 1g10050�6 (if applicable)
�
AD�?TTIt�N�I,�NF��;�VIATIQl�T=V�ATER METE�tS
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.
� 2, Ic � � o �l
Applicant: .. �a�^- Date:
Original: 1-Address File
Make Copies For: 1- Utility Billing Department 1- Cash Drawer