HomeMy WebLinkAbout2009-00093 - water meter . , -�
CITY OF ORONO PERMIT NO.: 2009-00093
2750 KELLEY PARKWAY
ORONO, MN 55356- �ATE Iss[1En: 03/06/2009
952 249-4600 FAX: 952 249-4616
ADDRESS : 795 BRIDGEWATER DR
PIN : 33-118-23-12-0020
LEGAL DESC : STONEBAY FOURTH ADDITION
: LOT 009 BLOCK 001
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
NEPTUNE 1"WATER METER-SERIAL#51390857,ERT HIGH# 1820457080
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENT[AL 1
APPLICANT WATER METER RESIDENTIAL HORN 104.45
K& S PLUMBING LLC WATER METER RESIDENTIAL 394.67
9572 KNOX AVE.N. TOTAL 499.12
BROOKLYN PARK,MN 55444
(763)425-8760
Minnesota State License#: 065380-PM
OWNER
O.T. Development, LLC
LLC,O.T. DEVELOPMENT,
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 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 licant is responsible for assuring all required inspections are
re es�'ed in conformance with the State Building Code.This permit may be
re f �d at any time for due cause.
< �- �"�U�� `.� �.,��,`S� � � i �= i o t� 3 i � i 6
A licant Permitee Signature Date Iss ed By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
FOR CITY OSE ONLY
' � City of Orono G
" ¢ � Y.O.Box 66 Date Received:� D Permit# �� /' � ���
�Q��,, ��`�;1 2750 Kelley Parkway
�" ar ►�� Crystal[3ay,MN 55323 Approved By:(If Required):
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����1j ,�ya��f (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 Public Works Department*)
GENERAL INFORMATION
l. 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 instailation.
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: � q� 1�- r� � ��2 W C,�,�-Q,f�� �V'e-- �r0 y�� (�/� SS35(o
Owner: �� ��V�1o�CY12�'�-�� 1 ! Mailing Address: �6'7a �����-`-1�'t`�W�-�-(�lS
City: ��(`D►'1� f�/�Il� Zip: �S3S �p
Home Phone: 9'S•� —y�"1 (� - Dn3 Z Alternate Phone:
Contractor Information:
/ L-�C �
Contractor: ����M f7,� Contact Person: �� S v�`
'/- ',,� 6�,38'o r�
Address: �702 (�-�X�J N' State License #: -
City: DJ�I � � Zip�7y`� Expiration Date: �' 0��
Phone: 7�?a-38��3� Alternate Phone: 719-3—y����
WATER METER PERMIT FEES
WILL BE CAULULATED BY CITY STAFF
❑ 5/8" METER- ❑ 3/4" METER- � 1"METER-
� 5/8"HORN - ❑ 3/4" HORN - 1"HORN -
� "WATER METER (THESE WII,L HAVE TO BE SPECIAL ORDERED&PRICF,S DF.TERMINED)
1. METER FEE: $�� � (07
2. HORN FEE $ �U �� 7`�
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) � 7 / �- �v�
CITY-USE ONLY
* For Current Pricing Refer to Current Year - Water Meter Pricing Chart *
BRAND: _��j�l G���
SIZE: ❑ 5/8" ❑ 3/4" `�}" ❑Other "
SERIAL#: ,��� �1�',:�j� �
ERT HIGH#: IIIIIIIIIIIIIIIIIIIIIIIIIIIII (if applicable)
1820457080 —
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, cfn�l certifies that all statements made on this application are, true and correct.
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Applica : ��� S�- �V��� Date: � "�f1 '��"1
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Reset �orm
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Original: 1-Address File
Make Copies For: 1- Utility Billing Department 1-Cash Drawer