HomeMy WebLinkAbout2012-00164 - water meter -�
- CITY OF ORONO * 2 0 1 Z — 0 � 1 6 4 *
27�0 KELLEY PARKWAY DATE ISSUED: 03/OU2012
ORONO, MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 2470 COBBLESTONE CT
PIN : 33-118-23-11-0080
LEGAL DESC : STONEBAY SIXTH ADD[TION
: LOT 002 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 �
WATER METER RESIDENTIAL HORN 1 WATER METER RESTDENTIAL I
APPLICANT
WATER METER RESIDENTIAL 303.70
K& S PLUMBING LLC WATER METER RESIDENTIAL HORN 86.64
9572 KNOX AVE.N. TnTai 39034
BROOKLYN PARK, MN 55444
(763)425-8760
Minnesota State License#: 065380-PM
City of Oror�,
OWIVER °"50 Kelley Rarkway
O.T. Development. LLC Gi uno MN �55356 95�-249-460G
10300 ]OTH AVE N Receipt 1+�,: ,'�.00649U Mar i, 201c
PLYMOUTH, MN 55441-
K � S Plumbina
AGREEMENT AND SWORN STATEMENT Previous Balance: .{NJ
5ale Of Wtr Meter
The work for which this permit is issued shall bc performed according to c47d �ObbiBSt�YiB l.t �/N �`�U.34
[he approved pians and specifications,applicable City approvals,and the 1�17i 17�
State Building Code. This permit is for only the work described and does 601-39610
not grant permission for additional or related work which reyuires separate Miseellar�ous Rever�ue
permits. All provisions of laws and ordinances governing this type of work '--""—'---'—'
shall be compied with whether or not specified herein.This permit will TG�dl C .�,9U.S4
expire and become null and void if construction authorized is not —""' '°—O°'
commenced within 180 days of the date of issuance,or if construction is ��k
suspended for a period of 180 days at any time after work has commenced. CFIeCIt N0: 4344 ��.�F
The applicant is responsible for assuring all required inspections are Payor:
requested in conformance with the State[3uilding Code.This permit may be K 6 5 Plu�bing
revoked at any time for due cause. Total Rppl ied: ___ ____390.34_
/ / ^� _ , / /
Applicant Permitee Signature Date lssued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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FOR C1TY USE ONLY
����'� City of Orono
;��O�\� P.O.Box 66 Date Received: Permit#
� �n, ��` 3750 Kelley Parkway
��a �,1�' �`,"�` �) Crystal Bay,MN 55323 Approved By:(lf Required):
�'��d� �`��' '�r.o�� (952)249-4600
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CITY OF ORONO—WATER METER FORM
(*Note:Some permits may require approval by the Building Official ancUor Public Works Depanment*)
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 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 �Additional Meter—For: � Replacement Meter
Job Site/Owner Information:
Site Address: .����7� �'����F�S�U,�� �� _
Owner:_U<� ��,J���y��.U� Mailing Address: �(�.�C�� /��/�J �.
c�ry: p������,_ ��1�1 /� z;p: SryH�
Home Phone: Alternate Phone:
Contractor Information:
/ !i c � o
Contractor: 1-S . (i,t� �..� Contact Person: _Scu`�( S����s��
L �'
Address: �s7� �^�� ,�/... iV. State License #: � 6' f�C�'S
City: ���� ,� p,� Zip:�"� Expiration Date: � '3� �-
Phone: ��'��``��'-���U Alternate Phone: ���'. ��-J` �`3`
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� � �WATER METER PERMIT FEES �� � � �
WILL BE CAULULA':TED BY CITY STAFF � �
❑ 5/8"METER- 3/4"METER- � 1"METER-
� �/8"HORN - �3/4"HORN - � 1"HORN -
� "WATER METER (THESE WILL HAVE TO BE SPECIAL ORDERED&PRICES DETERMINED)
1. METER FEE: $ �Li--3 ' ��
2. HORN FEE $ p � ' � �
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) $ �� / � � `3�
CITY-USE ONLY
* For Current Pricing Refer to Current Year- VVater Meter Pricing Chart *
BRAND: 1� � ���"'1 ��'1�.-. sia
52239035
SIZE: ❑ 5/8" [�3/4" ❑ l" ❑Other " / III I I II III I IIIIIIIII II I II
��
SERIAL#: �
ERT HIGH#: �����������������l����!������ (if applicable)
1831711753
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, an ce tifies that all statements made on this application are,true and correct.
Applicant: Date: 3 ( � �
Reset Form
Original: 1-Address File
Make Capies For: 1- Utility Billing Deparinzent 1-Cash Drawer