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Home My WebLink About2011-01101 - water meter CITY OF ORONO PERMIT NO.: 2011-01101 ' "'� 2750 KELLEY PARKWAY ORONO, MN 55356- DATE �SS[1En: 09/23/2011 952 249-4600 FAX: 952 249-4616 ADDRESS : 120 CREEK RIDGE PASS PIN : 03-117-23-12-0014 LEGAL DESC : CREEKS[DE IN ORONO : LOT 003 BLOCK 001 PERMIT TYPE : WATER METER PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : WATER METER NOTE: 1NSEPCTIONS ARE DONG BY PUBL[C WORKS DL'PAR"I'MENT. TO SET-UP AN INSPECTION,PLEASE CALL:(952)249-4613 1" NEPTUNE WATER METER SERIAL#51390854 ERT HIGH# 1820458142 WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1 APPLICANT WATER METER RESIDENTIAL 392.92 BLUE WATER PLUMBING WATER METER RESIDENTIAL HORN 104.45 5026 ALPHA ROAD PRINCETON, MN 55371 MISC FEE 0.00 (763)238-1002 TOTAL 497.37 OWNER GUSTAFSON, MICHAEL& SUSAN 1000 SHELARD PKWY#300 MINNEAPOLIS, MN 55426- AGREEMENT AND SWORN STATEMENT The 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 ot�work shall be compied with whe[her 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 I 80 days at any time after work has commenced. The applican[is responsible for assuring all required inspections are requested in conformance with the State[3uilding Code.This permit may be revoked at any time for due cause. �� / / � �-� �/ �/� Applicant Permitec Signature Date Issu y Signature Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. � � FQR ITY SE ONLY �----=_, c s City of Orono / I��O��0�� P.O.Box 66 Date Received:� Permit#�'j—�`�`-"� /D/ ;�,,..,,, 2750 Kelley Parkway ,I� Jj�'!`r� �I Crystal Bay,MN 55323 Approved By:(If Required): \ � �yj.�G� �9$�.�249-46�� \��XO�� CITY OF ORONO—WATER METER FORM (*IYote: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 oossible,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 wam us that the fax is coming. 3. WATER NIETERS 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) �ew Meter � Additional Meter—For: � Replacement Meter Job Site/Owner Information: Site Address: /�v Cr�K �� 4. ss Owner: Mailing Address: City: Zip: Home Phone: Alternate Phone: Contractor Information: Contractor: B�� u'i0��'`� ��'M�� Contact Person: v �'�� OQ Y"�� Address: sv��' ��PhO` � State License #: S 77 / City: � � ^+t-�-�'aN Zip:s�37/ Expiration Date: /o� ' 3�� l Phone: ?�3 `3�7` 0�� Alternate Phone: ��' 3' �;g� �� . r WATER METER PERMIT FEES WILL BE CAULULATED BY CITY STAFF /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 DETEIL111NED) 1. METER FEE: $ � � � . �o�—� 2. HORN FEE $ � v �' �S 3. TOTAL PERMIT FEE(Add Lines 1-2 Above) $ � ` �' " � CITY-USE ONLY * For Current Pricing Refer to Current Year- Water Meter Pricing Chart * BRAND: SIZE: � ��/8" ❑ 3/4" �1" ❑Other " SERIAL#: /� 5��'S� �� ERT HIGH#: � ��S �� (if applicable) 1820458142 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: Date: �'�� 3'�� Reset Form �;`A� . Origi�zal: 1-Acldress File Mnke Copies For: /- Utiliry Billing Deparhnent 1- Cash Drawer