HomeMy WebLinkAbout2011-01380 - water meter � • � CITY OF ORONO PERMIT NO.: 2011-01380
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE ISSUED: 1UO2/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 764 BRIDGEWATER DR
PIN : 33-118-23-11-0110
LEGAL DESC : STONEBAY FOURTH ADDITION
: LOT O15 BLOCK 001
PERMIT TYPE : WATER METER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER METER
NOTE: INSEPCTIONS ARE DONE BY PUBLIC WORKS DEPARTMENT.
"['O SET-UP AN INSPECTION,PLEASE CALL:(952)249-4613
3/4" WATER METER
SERIAL#52239033
ERT HIGH# 1831713052
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 303J0
K& S PLUMBING LLC WATER METER RESIDENTIAL HORN 86.64
9572 KNOX AVE.N.
BROOKLYN PARK,MN 55444- TOTAL 390.34
(763)425-8760
Minnesota State License#: 065380-PM
OWNER
O.T. Development, LLC
10300 IOTH AVE N
PLYMOUTH, MN 55441-
AGREEMENT AND SWORN STATEMENT
'I'he work for which this permit is issued shall be performed according to
the approved plans and specitications,applicable City approvals,and the
State[3uilding 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 pertnit will
expire and become null and void if construc[ion 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
requeste -rff aonformance with the State Building Code.This permit may be
revoke� at any time for e aus ?
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App1icaTit Perm' Signature Date Issu By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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FO C Y USE ONLY
� ��'`� City of Orono I� �j
��� ¢ `�' �` P.O.Box 66 Date Keceived: / Permit#�b �� � `-'
a`„,�„� �� 2750 Kelley Parkway
�,` �j y'��'. ��I Crystal Bay,MN 55323 Approved By: [f Required):
����'��j���+.o/ (952)249-4600
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CITY OF ORONO-WATER METER FORM
(*Note:Some permits may require approval by the Building Ofticial and/or Public Works Dcpartment*)
GENERAL INFORMATION
1. WATER METERS must be picked up and paid for at City Hall.
2. If�ossible,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. Alsq 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
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Job Site/Owner Information:
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Site Address: j(7`1 /';� ,p ���/�f�P/j ��O�J�
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
LCC /
Contractor: '�--� Gl/� %�' Contact Person: .��� ,5�,�,lCS��,
Address: �57�? ��-t�j� �. State License #:
City: ��a��l��i� ���l Zip.�`r��� Expiration Date:
Phone: �763-�3�-573�� Alternate Phone:
WATER METER PERMIT FEES
WILL BE CAULULATED BY CITY STAFF
❑ 5/8"METER- 4"METER- � 1"METER-
� 5/8"HORN - "HORN - � 1"HORN -
� �"WATER METER (THESE WILL HAVE TO BE SPECIAL ORDERED&PRICES DETERtiI1NED)
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:
SIZE: ❑ 5/8" 3/4" ❑ 1" ❑Other "
SERIAL#: � ��� c"j ��3
ERT HIGH#: IIl�II���I��������������l��l� (if applicable)
1831713052
ADDITIONAL 1NFORMATION—WATER METERS
The undersigned hereby applies to the City of Orono for issuance of a water meter perinit, 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.
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ApplicantL.,-�� Q �� Date: N� ��
Reset Form ;;
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O�•iginal: I-Address File
Make Copies For: 1- Utiliry Billing Department 1- Cash Drawer