HomeMy WebLinkAbout2012-00616 - water meter , . . CITY OF ORONO * z 0 1 z - B 0 6 1 6 *
2750 KELLEY PARKWAY DATE ISSUED: 06/28/2012
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2807 CASCO PO[NT RD
PIN : 20-117-23-32-0014
LEGAL DESC : SPR[NG PARK
: LOT 123 BLOCK 000
PERMIT TYPE : WATER METER- RESIDENTIAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER METER- RESIDENTIAL
NOTE: INSEPCTIONS ARE DONG BY PUBLIC WORKS DEPARTMEN'I'.
TO SET-UP AN INSPECTION,PLEASE CALL:(952)249-4613
3/4° METER HORN-REYLACING EXISTING HORNS
WATER METER RESIDENTIAL HORN 0
APPLICANT WATER METER RESIDENTIAL HORN 86.64
MATT'S PLUMB[NG SOLUTIONS
5565 164TH AVE NW TOTAL 86.64
RAMSEY, MN 55303- PAID WITH CC# 7281
(651)341-5899
Minnesota State License#: 068021-PM
OWNER
BAILEY,JOHN& PATRIC[A
2807 CASCO POINT RD.
WAYZATA,MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be pertormed according[o
Ihe approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for only the work described and does
not gran[permission for additional or related work which requires separate
permi[s. 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 I 80 days at any time after 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
revo t a y ti for du cause.
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Appl�cant Permrtee Signature Date [ssu d By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK O HER THAN DESCRIBED ABOVE.
_ . .
F R CI Y USE ONLY
�'�j�'�� City of Orono n
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f � � �'�� P.O.Box 66 Date Receiv .� �ermit# (/
�i �� , �1' 2750 Ikelley Parkway,
t�� �11y�` '- ���;� Crystal Bay,MN 5�333 Approved By:(]f Required):
\a �'' � .,z.o�if (952)249-4600
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CITY OF ORONO—VVATER METER FORM
(*Note: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. If possible,fax in this application ahead of time;we will then cal]you and let you know we have
the water meter in stock. Fax Number: (952)249-4616. Also,you can cal] ahead of time to make
sure we received the fax,or to wam 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 �Additiona] Meter—For: � Replacement Meter
Job Site/Owner Information:
Site Address: �� � �� ��L
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
� S�/uf/a ys /�j �Q � �
Contractor: ��� S�llif/�j%/✓J° Contact Person: / ��� //-� ��
Address: �S�j ��y�h�de Nl,� State License #: � � � ��
City: �1�� Zip:SS-3��Expiration Date: I oZ — p�0 ! �
Phone: �,)�—J �� �g��-J Alternate Phone: �j ��� ��� S g�
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VVATER IVIETER PERMIT FEES
WILL BE C1AliLULATED 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: $
2. HORI`T FEE $ �
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) $
CITY-USE ONLY
* For Current Pricing Refer to Current Year- Vl�'ater Meter Pricing Chart *
BRAND:
SIZE: ❑ 5/8" ❑ 3/4" ❑ 1" ❑Other "
SERIAL#:
ERT HIGH#: (if applicable)
ADDITIONAL 1NFORMATION—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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pplicant: Date: �lJ r � �/ �
` Reset Form
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Orzginal: 1-Address File
Make Copies For-: 1- Utility Billing Department 1- Cash D��awer