HomeMy WebLinkAbout2011-01146 - water meter . CITY OF ORONO PERMIT NO.: 2011-01146
� ' 2750 KELLEY PARKWAY
r ORONO, MN 55356- DATE �sSUEu: 09/29/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 115 CREEK RIDGE PASS
PIN : 03-117-23-12-0013
LEGAL DESC : CREEKSIDE IN ORONO
: LOT 002 BLOCK 001
PERMIT TYPE : WATER METER
PROPERTY TYPE : RESIDENTIAL
COIVSTRUCTION TYPE : WATER METER
NOTE: INSGPCTIONS ARE DONG BY PUBLIC WORKS DEPARTMGNT.
TO SET-UP AN INSPECTION,PLEASE CALL:(952)249-4613
1" WATER MF.,TER
SERIAL# 51390824
GR"['I IIGH# 18204581 17
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 392.92
STEWART PLUMBING, INC. WATER METER RESIDENT[AL HORN 104.45
13025 GEORGE WEBER DR TOTAL 497.37
SU[TE#1
ROGERS, MN 55374
(763)428-1833
OWNER
PFEIFER,ANDY& MARNIE
1 15 CREEK RIDGE PASS
LONG LAKE, MN 55356-
AGREEMENT AND SWORN STATEMENT
I'hc work for���hich this permit is issued shall be perrormcd 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 crant permission tor additional or related work which requires separate
permits. All provisions of laws and ordinances governing Ihis type of�work
shall be compied wi[h whether or not specitied herein.This permit will
expire and become null and void if construction authorized is not
commenced�vithin 180 days of the date of issuance,or if construction is
suspended for a period of 180 days at any time afrer work has commenced.
The applicant is responsible for assuring all required inspec[ions are
requested in conformance with the State Building Code.This pennit may be
revoked at any time for due cause.
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Applicant Permitee Signature Date Issu By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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C[ Y USE ONLY
�%��', City of Orono � /�
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�� ¢ �� P.O.Box 66 Date Receiv :� Permit# D 6
i/ _ '� ��' 2750 Kelley Parkway
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� �j'�'x,` �.1, Crystal Bay,MN 55323 Approved By:(If Required):
��� �i�'�%�:ryo`/ (952)249-4600
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CITY OF ORONO—WATER METER FORM
(*Note:Some permits may require approval by the Building Ofticial 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 A 1
[�Residential (May Require Approval) ❑ Commercial (Approval Required)
�New Meter � Additional Meter—For: � Replacement Meter
Job Site /Owner Information:
Site Address: i l `� (� ��� �� �,���,� �°`�'�
Owner: L �`'r`�� �u��� Mailing Address:
,r'' n L
City: J Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor: ���'W,.r fi �`ir�.1�;, �,r(., �er•� ��--I�.L d�
� � Contact Person:
Address: 1���� ���' ''��- ��'� �� State License #:
�� �t � I
City: c �� Zip:�9�31 y Expiration Date:
Phone: ?6-�- ��' ��� �7 Alternate Phone:
'�r •
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WATER METER PERMIT FEES
WILL BE CAULULATED BY CITY STAFF
❑ 5/8"METER- ❑ 3/4"METER- "METER-
� 5/8"HORN - ❑ 3/4"HORN - "HORN -
� "WATER METER (THESE WILL HAVE TO BE SPECIAL ORDERED&PRICES DETERti1INED)
1. METER FEE: $
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: _ �E. �� V�-� �
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SIZE: ❑ 5/8" ❑ 3/4" �-1-" ❑Other "
SERIAL#: � I � / � ��
ERT HIGH#: ��IIII IIIIIIIIIIIIIIII IIIIIII (if applicable)
1820458117
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.
Applicant: � L�`�G-r� Date: �/ � y/� �
Reset Form
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O�•iginal: 1-Address File
Make Copies Fo�•: I- Utility Billing Depm•tment /-Cash Dr�ative�•