HomeMy WebLinkAbout2008-00407 - water meter � CITY OF ORONO PERMIT NO.: 2008-00407
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE IssuEn: 1U2U2008
� (952) 249-4600 FAX: (952) 249-4616
ADIIRESS : 766 BRIDGEWATER DR
PIN : 33-118-23-1 1-0109
LEGAL DESC : STONEBAY FOURTH ADDITION
: LOT 014 BLOCK 001
PERMIT TYPE : WATER METER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER METER
NOTE: tNSEPCTIONS ARE DONE BY PUBLIC WORKS DEPAR"1'MENT.
TO SET-UP AN INSPEC"1'ION,PLEASE CALL:(952)249-4613
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENT[AL 1
APPLICANT WATER METER RESIDENTIAL 3]2.40
PLUMB RIGHT WATER METER RESIDENTIAL HORN 6].00
1216 82ND. AVE N �
BROOKLYN PARK, MN 55444- TOTAL 373.40
(763)561-3306
Minnesota State License#: 058734
OWNER
Z B Construction, [nc.
2670 KELLEY PKWY
ORONO, 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 [he
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 specitied herein.This permit will
expire and become null and void if consVuction 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 requircd inspections are
reques[ed in conformance with the State Building Code.This permit may be
revoked at any time for due cause. � ,�i
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Applicant Permitee Signature Datc ������� �� � �
Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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t FOR CITY USE O1VLY �,�
' �"�-"�� City of Orono �<�- �( (�
� �� �� P.O.Box 66 DaCe Received: �( ��� `�Permit# ��W �
� fl�,�,, , �� 2750 Kelley Parkway
"� �ly�`� h' Crystal Bay,MN 55323 Approved I3y:(If Required):
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\,� � ��yaf/ (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 Publie Works Department*)
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. 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) ❑ Commercia] (Approval Required)
�New Meter �Additional Meter—For: �Replacement Meter
Job Site/Owner Information:
Site Address: �' � ✓ .�._,�
Owner: ��- � Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
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Contractor: Contact Person:
Address: lvZ��' '' � -..vU�State License #: ���/,j����
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City: ��� � 'Zip: � S��'Expiration Date: ��' 3�D�
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Phone: ��'�)�/ 3� _/`�� Alternate Phone:
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� VVATER METER PERMIT FEES �
• WILL BF, CAULULATED BY CI I'Y STAFF
❑ 5/8"METER- 3/4"METER- � 1"METER-
❑ 5/8"HORN - �3/4"HORN - � 1"HORN -
❑ "WATER METER (THESE WILL HAVE TO BE SPEC[AL ORDERED&PRICES DETERMINED)
1. METER FEE: $ `J�� � �U
2. HORN FEE $ C�J� . �
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) $ �� � - ��
CITY-USE ONLY
* For Current Pricing Refer to Current Year- Water Meter Pricing Chart *
BRAND: 7��.J� �.)f"i.,� �'l�
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SIZE: ❑ 5/8" �]3/4" ❑ 1" ❑Other "
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SERIAL#: � � �� L--/ I �j
ERT HIGH#: ����������������������������I (if applicable)
1810193230
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.
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Applicant: — Date: � ;%�
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� Reset Form
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Orzginal: 1-Address File
Make Copies For: 1- Uti[iry Billing Department 1-Cash Drawer