HomeMy WebLinkAbout2010-00166 - water meter '� �. CITY OF ORONO PERMIT NO.: 2010-00166
2750 KELLEY PARKWAY
1 "•'�"" ORONO, MN 55356- DATE ISSUED: 03/23/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 2755 ETHEL AVE
PIN : 20-117-23-24-0017
LEGAL DESC : CASCO HEIGHTS
: LOT 006 BLOCK 003
PERMIT TYPE : WATER METER
PROPERTY TYPE : RESIDENTIAL
COIVSTRUCTION TYPE : WATER METER
NOTE: INSEPCTIONS ARE DONE BY PUBLIC WORKS DEPARTMF.NT.
TO SET-UY AN INSPECTION,PLEASE CALL:(952)249-4613
WATER METER RESIDENTIAL HORN ] WATER METER RESIDENTIAL 1
APPLICAIVT WATER METER RESIDENTIAL 268.05
COPELAND, DAVID WATER METER RESIDENTIAL HORN 66.83
2755 ETHEL AVE
WAYZATA, MN 55391- TOTAL 334.88
(612)812-8161 PAID WITH CC# 7024
OWNER
COPELAND, DAVID
2755 ETHEL AVE
WAYZATA, MN 55391-
AGREEMEIYT 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[3uilding 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 rype of work
shall be compied with whether or not specified hercin.This permit will
expire and becomc 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 confonnance with thc State Building Code.This permit may be
revoked at any time for due cause.
� �� / / / /
A pl�cant Perm�t �gnature Date [ssued By � nature D te
SEPARATE PERMITS REQU[RED FOR WORK OTHER THAN DESCRIBED AB .
• � � FOR C1TY USE ONLY
,�0� City of Orono
O O P.O.Box 66 Date Received: Permit#
�;;,,,,,,,, 2750 Kelley Parkway
�a ��'S�;<}= �• Crystal Bay,MN 55323 Approved By:(If Required):
� 1�F;�G ti
����.�o (952)249-4600
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 vossible,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 instaliation.
TYPE OF PERMIT
(Check All That Apply)
�Residential(May Require Approval) ❑ Commercial(Approval Required)
�-��w Meter ❑Additional Meter—For: eplacement Meter
Job Site / Owner Information:
Site Address: -Z � S� ����, �
Owner: av' c�a� Mailing Address: ���� • � I—�-�.,�f,,,
City: �r�D Zip: ���0.�'
Home Phone: Alternate Phone:
Contractor Information:
Contractor: Contact Person:
Address: State License#:
City: Zip: Expiration Date:
Phone: Alternate Phone:
� �!
WATER METER PERMIT FEES � .
WILL BE CAULULATEDBY CITY STAFF
j��,�],�/8"METER- ❑ 3/4"METER- ❑ 1"METER-
� �J 5/8"HORN - ❑ 3/4"HORN - ❑ 1"HORN -
i �
❑ "WATER METER (THESE WILL HAVE TO[3E SPECIAI.ORDERED&PRICES DETERMINED)
l. 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: ������
SIZE: �5/8" ❑ 3/4" ❑ 1" ❑ Other "
SERIAL#: 8�3059 7
ERT HIGH#: ����������������������������� if a
i830�2y��2 (� pplicable)
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 ardinances 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:� � /`'J Date: � '�� '��_
Original: 1-Adclress File
Make Copies For: 1- Utiliry Billing Department 1- Casli Drawer