HomeMy WebLinkAbout2010-00170 - water meter t . � CITY OF ORONO PERMIT NO.: 2010-00170
2750 KELLEY PARKWAY
ORONO, MN 55356- �ATE IssuEn: 03/25/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 3105 CASCO POINT RD
PIN : 20-117-23-34-0006
LEGAL DESC : REG. LAND SURVEY NO. 1311
: LOT 000 BLOCK 000
PERMIT TYPE : WATER METER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER METER
NOTE: INSEPCTIONS ARE DONE BY PUBLIC WORKS DEPARTMEN"1'.
TO SET-UP AN INSPECTION,PLEASE CALL: (952)249-4613
PURCHASE OF 5/8° HORNS ONLY
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 0
APPLICANT WATER METER RESIDENTIAL 0.00
STEWART PLUMBING, INC. WATER METER RESIDENTIAL HORN 66.83
13025 GEORGE WEBER DR
SUITE#1 MISC FEE 0.00
ROGERS, MN 55374 TOTAL 66.83
(763)428-1833 PAID WITH CC# 3424
OWNER
RICHEY, KENT& SUE
3105 CASCO PT RD
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
Thc 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 Yor a period of l80 days at any time after work has commenced.
'�he applicant is responsible for assuring al �'equired inspections are
requested in confomtance with the Sta uilding Code.This permit may be
revoke ny time �r due cause.
�
�� l l � �z�� �l �s'.� /C�
Applicant Per itee Si ature Date ssue y Signature Date
SEPARATE PERM[TS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
. � J ��5�-.
. �
��
FOR CITY USE ONLY
,��� City of Orono � �
� � P•O.Box 66 Date Received: Permit#
�;,,� 2750 Kelley Parkway
a ��'�;'s, � Crystal Bay,MN 55323 Approved By:(If Required):
\�t 4�l�t,, tiF
�t����;�.�o (952)249-4600
�c�Ko
CITY OF ORONO—WATER METER FORM
(*Note:Some permits may require 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 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 Apply)
❑ Residential(May Require Approval) ❑ Commercial(Approval Required)
❑ New Meter ❑ Additional Meter—For: � ❑ Replacement Meter
Job Site / Owner Information:
Site Address: � � � S ��r s c� � �r. �u�
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractar: S�'J��;" � ���''"� `'"`� Contact Person: J�c", fi c�� S�� (��--
Address: State License #:
City: /�d �-- � Zip: Expiration Date:
Phone: �b j' yl�- /�3 3 Alternate Phone:
� ��
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"�IORN -
v vw
❑ "WATER ME ER (THESE WILL HAVE TO BF SPECIAL ORI)ERED&PRICES DETERM[NED)
i. METER FEE: $
2. HORN FEE $
3. TOTAL PERMIT FEE (Add Lines i-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#: ��(l� ����'f �7 ��
ERT HIGH#: � ���� a ��J� (if applic ble)
ADDITIONAL INFORMATION—WATER METERS
The undersigned hereby applies to the City of Orono for 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.
Applicant: Date:
Original: 1-Adclress File
Make Copies For: 1- Utility Billing Department 1- Cash Drawer