HomeMy WebLinkAbout2011-01524 - water meter CITY OF ORONO PERMIT NO.: 2011-01�24
! ' • 2750 KELLEY PARKWAY
ORONO, MN 55356- DATE IssuEn: 12/07/2011
9�2 249-4600 FAX: 952 249-4616
ADDRESS : 764 BRIDGEWATER DR
PIN : 33-118-23-I1-0110
LEGAL DESC : STONEBAY FOURTH ADDITION
: LOT O15 BLOCK 001
PERMIT TYPE : WATER METER
PROPERTY TYP� : RESIDENTIAL
CONSTRUCTION TYPE : WATER METER
NOTE: INSEPCTIONS ARE DONE BY PUBLIC WORKS D�PARTMENT.
TO SET-UP AN INSPECTION,PLEASE CALL:(952)249-4613
And
REPLACE 3/4"METER HEAD bi0 BATTERY. PRICE PER SCOTT
ERT- 1831377188
WATER METER RESIDENTIAL 0 VALUATION OF PLUMBING 0
APPLICANT WATER METER RESIDENTIAL 172.85
O.T. Development, LLC
10300 l OTH AVE N STATE SURCHARGE PLBG(VALUATION) 15.13
PLYMOUTH,MN 55441- TOTAL 187.98 �
PAID WITN CC# 3796
OWNER
O.T. Development, LLC
]0300 l OTH AVE N
PLYMOUTH, MN 55441-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed accordin�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 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 autho�ized is not
commenced within 180 days of the date of issuance,or if construction is
suspended for s period of 180 days a[any time afrer 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
revoked at any time for due cause.
/ / / /
Applicant Permitee Signature Date Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
� • '4
FO CI Y USE OPILY �
///�"����`� City of Orono �2 / ,,, �,�
�� `rO�` P.O.Box 66 Date Received: � Permit# �OI �
� 'I 2750 Kelley Parkway
�.. ...
1'��
�� 1�� -;� -�! Crystal Bay,MN 55323 Approved By:(If Required):
`\ �' r%:,+�,o` (952)249-4600
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CITY OF ORONO—WATER METER FORM
(*Note:Some pennits 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: l
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor: �� L.CJ`t,S���b'Eontact Person: �����
Address: ��� E3tr'1f�,�L.i��State License#:
City: O�U�� Zip:Gi?� �E piration Date:
Phone: �7���(� " �'7 OU Alternate Phone:
,� , .
WATER METER PERMIT FEES
WILL BE CAULULATED BY CITY STAFF
❑ 5/8"METER- ❑ 3/4"METER- � 1"METER-
� 5/8"HORN - ❑ 3/4"HORN - B 1"HORN -
� "WATER METER (THESE WILL HAVE TO BE SPECIAL ORDERED&PRICES DETERMINED)
l. METER FEE: -�,.� ��r"\ — $ � G �' ��
� ✓� d ��
� l5 � 13
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: ` V� � `"�'" `��
SIZE: ❑ 5/8" �4" ❑ 1" ❑ Other "
SERIAL#: L � � L �
ERT HIGH#: (if applicable)
ADDITIONAL INFORMATION—WATER METERS
The undersigned hereby applies to the City of Orono far issuance of a water meter perniit, agrees
to do all work in strict accordance with the ordinances of the City and the regulations of the State
of Minnesota,an ce � s that all statements inade on this application are,true and correct.
Applican . Date: �_ � �d�j
Reset Form
Original: 1-Address File
Make Copies For: I- Utility Billing Deparhnent I-Cash Drawer