HomeMy WebLinkAbout2009-00055 - water meter /
� �` CITY OF ORONO PERMIT NO.: 2009-00055
2750 KELLEY PARKWAY
ORONO, MN 55356- �ATE ISsuE�: 02/1U2009
952 249-4600 FAX: 952 249-4616
ADDRESS : 3935 SHORELINE DR
PIN : 20-117-23-22-0002
LEGAL DESC : TOWNSITE OF LANGDON PARK
: LOT 001 BLOCK 008
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
5/8" METER HORN ONLY
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 0
APPLICANT WATER METER RESIDENTIAL 0.00
BEDELL, MR.& MRS. JAMES WATER METER RESIDENTIAL HORN 66.83
3935 SHORELINE DR
SPRING, MN 55384 TOTAL 66.83
PAID WITH CASH 66.83
OWNER
BEDELL, MR. &MRS. JAMES
3935 SHORELINE DR
SPRING, MN 55384
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 permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing 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 a[any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Buildi g Code.This permit may be
revok at any time for due cause.
.f��� S/ � � � �l �l l !� �'
Ap licant Permitee Signature Date �� � ��
Iss d By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
� �
FQR CIT USE ONLY
� City of Orono �C/
�� �� P•O.Box66 DateReceivedJ��� Permit# UC� �9— ��5�
�;;,.�,,, 2750 Kelley Parkway
a ,���r;4�<,-'�. Crystal Bay,MN 55323 Approved By:(If Required):
���H�yc� (952)249-4600
CITY OF ORONO—WATER METER FORM
(*Vote: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 Apply)
�I�esidential(May Require Approval) ❑ Commercial(Approval Required)
❑ New Meter ❑ Additional Meter—For: ❑Replacement Meter
Job Site/ Owner Information:
Site Address: ��� 3� J���� � ' �� 1� r �
Owner: ��m� S � �'�e�� � Mailing Address: ��S u ���r L�'v� t-'N
c�ty: �IZ t� �� v z�p: 5-5-3 L �l
Home Phone: ( S� ����� �1�� Alternate Phone:
Contractor Information:
Contractor: � l ( Q`��' � ` Contact Person: � ' � �
Address: J��/n� �/9/� State License#:
City: Zip: Expiration Date:
Phone: �n 1� O / 7 ���� Alternate Phone:
. y
� WATER METER PERMIT FEES
WILL BE CAULULATED BY CITY STAFF
❑ �/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 O 1u �� $ �Q cU, CC.��
�
3. TOTAL PERMIT FEE(Add Lines 1-2 A ove) $ "
CITY-USE ONLY
* For Current Pricing Refer to Current Year- Water Meter Pricing Chart *
BRAND:
sizE: ❑ sis°� ❑ 3i4°° ❑ i�° ❑ other „
SERIAL#:
ERT HIGH#: (if applicable)
ADDITIONAL INFORMATION—WATER METERS
The undersigned hereby applies to the City of Orono far issuance of a water meter permit, agrees
to do all wark in strict accordance with the ardinances of the City and the regulations of the State
of Minnesota, and certifies that all statements made on this application are, true and correct.
,
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Applicant: �%�'(�-�J �� ' � Date: �� ��� d/
Original: 1-Adrlress File
Make Copies For: 1- Utiliry Billing Department 1- Cash Drawer