HomeMy WebLinkAbout2009-00436 - water meter � 1
CITY OF ORONO PERMIT NO.: 2009-00436
2750 KELLEY PARKWAY
ORONO, MN 55356- �ATE IssvEn: 07/27/2009
952 249-4600 FAX: 952 249-4616
ADDRESS : 2623 CASCO POINT RD
PIN : 20-117-23-24-0032
LEGAL DESC : SPRING PARK
: LOT 141 BLOCK 000
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
NEW 5/8"METER-SERIAL NUMBER-83265422-ERT HIGH- 1810233768
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 268.05
SIERRA HOMES INC. WATER METER RESIDENTIAL HORN 66.83
22615 E.BETHEL BLVD NE
BETHEL,MN 55005- TOTAL 334.88
(612)270-2722
Minnesota State License#: 5126
OWNER
KUBALAK,THOMAS&PATRICIA
2623 CASCO POINT RD
WAYZATA,MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifica[ions,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 no[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 Yor 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 ss ed By Sig ure Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
a �
FOR CITY USE ONLY
O4�,►` City of Orono 7/ /� �1 �
`�'O P•O.Box 66 Date Received.a 7(� Yermit# �U7��/Q �
�:�s,e„�,, 2750 Kelley Parkway
� ,�1�'�<'��. � Crystal Bay,MN 55323 Approved By:([f Required):
a������o (952)249-4600
CITY OF ORONO-WATER METER FORM
(*hote:Some permits may rcquire 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. Ifpossible,fax in this applicarion 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, ar 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 Apply)
�]Residential(May Require Approval) ❑ Commercial(Approval Required)
�New Meter ❑ Additional Meter—For: ❑ Replacement Meter
Job Site/ Owner Information:
Site Address:
� �. � -� ����� �� �-�, ���
Owner:�C%��'t ��/'�?� f�v� (� �-�{� Mailing Address: ����`�� ��s-� r, ��' ��
City: �%�,'����� Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor:���-'�� ��"'"�' "��w�— Contact Person: � ��'`'l ��- ���-
�.� ��-�'� �
Address: ��-����S� �; �E ' State License#: ��1 <�-�
City: �c_��� � Zip: �5 S �'°�Expiration Date: �� � �
Phone: � � z �`� �' -��� `�� Alternate Phone: �L�5 ��3`� ��S � �
. �
�' 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 WILL HAVE TO BE SPECIAL ORDERED&PRICES DETERMINED)
1. METER FEE: $ ��o� U�
2. HORN FEE $ ��(� ,�'�
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) $ 3 � L�"� ��
CITY-USE ONLY
* For Current Pricing Refer to Current Year- Water Meter Pricing Chart *
BRAND: �-�IJt(� l�J�_
SIZE: (�-5/8" ❑ 3/4" ❑ 1" ❑ Other "
� S 7 ��
SERIAL#: � � ��
ERT HIGH#: � �� U �j �� � �[� � (if applicable)
ADDITIONAL 1NFORMATION—WATER METERS
The undersigned hereby applies to the City of Orono far issuance of a water meter permit, agrees
to do all wark 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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Original: 1-Adclress File
Make Copies For.• 1- Utility Billing Department 1- Cash Drawer