HomeMy WebLinkAbout2009-00821 - water meter CITY OF ORONO PERMIT NO.: 2009-00821
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 11/16/2009
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 850 WAYZATA BLVD W
PIN : 35-118-23-44-0004
LEGAL DESC : UNPLATTED 35 118 23
: LOT 000 BLOCK 000
PERMIT TYPE : WATER METER
PROPERTY TYPE : REyiI.D£NTIA—_%_r i i} tx_ i Sh0(;
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
•
APPLICANT WATER METER RESIDENTIAL 394.67
BITTER EXCAVATING WATER METER RESIDENTIAL HORN 104.45
7120 VERNON STREET
ROCKFORD,MN 55373 MISC FEE 0.38
(612)477-5649 TOTAL 499.50
Minnesota State License#: 1921
OWNER
OMS Properties LLC
760 HUNT FARM RD
LONG LAKE, MN 55356-
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 at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoke
me for due cause. ,/ P
pplicant Permitee Signa ure Date Issued By Si ature �� v�—�\ ate
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABO ^E.
_
••
1
4'1
fforrk
FOR CITY USE ONLY
c
o*0%
City of Orono
P.O.Box 66 Date Received: Permit#
2750 Kelley Parkway
.r Crystal Bay,MN 55323Approved By:(If Required):
• v (952)249-4600
y�ao��'
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 meter installation.
TYPE OF PERMIT
(Check All That Apply)
❑Residential(May Require Approval) ❑ Commercial(Approval Required)
❑ New Meter ❑Additional Meter—For: ❑ Replacement Meter
Job Site/Owner Information:
Site Address: j2- C „ / 6 /f--
Owners i.e-/ Mailing Address: f3-0 "7----; ,,
City: C2..t '�` Zip:
Home Phone:7�2-- '96 - 2-6”i Alternate Phone: /2 & 9 73-3--/J'
Contractor Information:
Contractor .),„ -A✓ JE 2/i ontact Person: _ .... /- _,
Address: 7f2-ZV 7/�e-z-, 4` State License #: 0 577 L It "`)---
City: ��
., J Zip:c.537Axpiration Date: /7 - 7/" 0
Phone: � ; 7 75-6 47,7 Alternate Phone: /.7Z -'/7'--,/q (
[ ser
r1
avow,
❑ 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: $ D
2. HORN FEE $ `O
_
. 3g
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) 99, $ d
CITY-USE ONLY
* For Current Pricing Refer to Current Year-Water Meter Pricing Chart *
BRAND:
SIZE: ❑ 5/8" ❑ 3/4" , f1" ❑ Other
SERIAL#: ill 111111111I II III11111111111
1820457186
ERT HIGH#: a57 39'O8 51 (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.
Applicant: � t/ G� — ��v Date: //--/
Original: 1-Address File
Make Copies For: 1- Utility Billing Department 1-Cash Drawer