HomeMy WebLinkAbout2009-00018 - water meter � � � CITY OF ORONO PERMIT NO.: 2009-00018
2750 KELLEY PARKWAY
ORONO, MN 55356- DATE IssUE�: OU22/2009
952 249-4600 FAX: 952 249-4616
ADDRESS : 2965 CASCO POINT RD
PIN : 20-117-23-31-0063
LEGAL DESC : REG. LAND SURVEY NO. 1470
: LOT 000 BLOCK 000
PERMIT TYPE : WATER METER
PROPERTY TYPE : REStDENT[AL
CONSTRUCTION TYPE : WATER METER
NOTE: INSEPCTIONS ARE DONE BY PUBLIC WORKS DEPARTMENT.
"('O SET-UP AN INSPECTION,PLEASE CALL: (952)249-4613
NPTUNE 5/8" WATER METER, SERIAL#86055549,ERT HIGH-#1820826628
WATER METER RESIDENTIAL 1
APPLICANT
WATER METER RESIDENT[AL 259.40
SWENSON,CLIFFORD TOTAL 259.40
2965 CASCO POINT RD
WAYZATA, MN 55391-
OWNER
SWENSON, CLIFFORD
2965 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 specitications,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 applicant is responsible for assuring all required inspections are
requested in coi� rmance with the State Building Code.This permit may be
revoked at��iy{v e for due cause. .�
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Appli " ermitee Signature Date � G �� / ' ���� / l�j l C
� ss ed E3y Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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FOI�CIT USE ONLY
,���� City of'Orono /��� � '��'_
� �� P.O.Box 66 Date Received:! �� Permit# � �
�;;,,� 2750 Kelley Parkway
� �y�'.�r�.:_ � Crystal Bay,MN 55323 Approved By:(It'Requ�red):
d ���,��o` (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
1. WATER METERS must be picked up and paid for at City Hall.
2. If possible, fax in this applicafion 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 co,ming.
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 Infornlation:
Site Address: �u��'�� �`,� � ��ti�� �)� ���X.
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Owner: L � , l ���_:�r�; Sv,.-� ' '�� ��/ �
l, 7 Mailing Address: �- t'� � (�� �� / f/ � �
City: �_��''->--�a' Zip: S S��(
Home Phone: `�SZ- �"/7��/-r1��� Alternate Phone: �1 �- -Z �� /�S�-' � ��c,( �J
Contractor Information:
Contractor: Contact Person:
Address: State License #:
City: Zip: Expiration Date:
Phone: Altemate Phone:
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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: $ ��� U
2. HORN FEE $
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.,Q���
SIZE: �5/8" ❑ 3/4" ❑ 1" ❑ Other "
SERIAL#: ���'�-`�_.�� �J�
ERT HIGH#: II�III II�I I��I I�I I����������I if a licable
182Q826628 �� PP )
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 certifie�-�f�at all statements made on this application are, true and correct.
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Applicant: ��`�1
; .�`" �" Date: J�Z�U �
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Original: 1-Address File
Make Copies For: 1- Utiliry Billing Department 1- Cash D�-awer