HomeMy WebLinkAbout2010-00040 - water meter CITY OF ORONO PERMIT NO.: 2010-00040
2750 KELLEY PARKWAY
, ORONO, MN 55356- DATE ►SSUE�: OU28/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 110 CREEK RIDGE PASS
PIN : 03-117-23-12-0015
LEGAL DESC : CREEKSIDE [N ORONO
: LOT 004 BLOCK 001
PERMIT TYPE : WATER METER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER METER
NOTE: [NSEYC'I'IONS ARE DONE BY PUl3LIC WORKS DGPARTMENT.
TO SET-UP AN INSPEC�I']ON, PLEASG CALL:(9�2)249-4613
WATER METER RES[DENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPL[CANT WATER METER RESIDENTIAL 394.67
SABRE HEATING&AIR COND [NC. WATER METER RESIDENT[AL HORN 104.45
3062 RANCHVIEW LN N TOTAL 499.12
PLYMOUTH, MN 55447
(763)473-2267 PAID WITH CC# 1 l l l
OWNER
JOHNSON, ANDREW
4215 TR[LLIUM LN E
MOUND, MN 55�64-
AGREEMENT AND SWORN STATEMENT
Thc work for which this permit is issued shall bc performcd according to
thc approved plans and spccifications,applicablc City approvals,and thc
State Building Codc. This permit is for only the work describcd and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinances governing this rype of work
shall be compied with whether or not specified herein.This permit will
expire and become null and void if construction auUiorized is not
commenced within 180 days of the date of issuance,or if construction is
suspcnded 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
revoked at any time Cor due cause.
/ / / /
Applicant Permitee Signature Date Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
� FOR C1TY USE OnLY
,�p� City of Orono �
P.O.Box 66 Date Received: ,I -��`l t Permit#
��;�_;,,,� � 2750 Kelley Parkway � h�
� ��`�'�,�:'�. � Crystal Bay,MN 55323 Approved By:(If Required): ; �
����`�,J��o� �9s2�2a9-a600 �?�� � �� ,
` l
��
CITY OF ORONO—WATER METER FORM
(*Note:Some permits may require approval by the Building Official and/or Public Worhs 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 rime;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 Infornlation:
Site Address: ///5 G(Y��< ����j�e.- i7�5 5
Owner: Mailing Address: ►�OC�Y��G. ���4�
City: ��6�0 Zip: �5 3��
Home Phone: Alternate Phone:
Contractor Infonnation:
Contractor: M Contact Person: (; ���
Address: �d�z �A����(J-t, ��/l,q�State License #: L��� �Q --��
City: PIy�D(,�� � Zip: 5��7ExpirationDate: �2�"�1�10
Phone:(7�,3� 7��' ZZb � Alternate Phone: ���2 � Z2/— �S`c�
WATER METER PERMIT FEES ,
� � WTLL BE CAULULATED BY CITY STAFF ,
❑ 5/8"METER- ❑ 3/4"METER- � 1"METER-
❑ 5/8"HORN - ❑ 3/4"HORN - � i"HORN -
❑ "WATER METER (THESE N'ILL HAVE TO BE SPECIAL ORDERED&PRICES DETERMIIED)
1. METER FEE: $ �j �j L�, �� `,
< </ S
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: �' � � ��� �'� '���-
d '
SIZE: ❑ 5/8" ❑ 3/4" �] 1" ❑ Other "
`% � `' �� " l � l � � 1
SERIAL#: -
lu!�'�„IIII I IIII II IIIII I II IIII
ERT HIGH#: 1$20841255 (if applicable)
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 ��vith 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: l'�� e
Original: 1-Address File
Make Copies For: 1- Utiliry Billing Depa�-tment 1- Cash Drawe�-