HomeMy WebLinkAbout2011-00344 - water meter � . `� CITY OF ORONO PERMIT NO.: 2011-00344
2750 KELLEY PARKWAY
' ORONO, MN 55356- DATE ISSUED: OS/16/2011
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1985 FAGERNESS POINT RD
PIN : 18-117-23-14-0004
LEGAL DESC : FAGERNESS
: LOT 003 BLOCK 000
PERMIT TYPE : WATER METER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER METER
NOTE: INSEPCTIONS ARE DONE BY PUI3LIC WORKS DF_PAR"fML'N'1'.
'CO SET-UP AN INSPEC'I�ION,PLEASE CALL: (952)249-4613
3/4" WATER METER
NEP7'UNE-EKT 1 IIG11#1820838304
SERIAL#51556977
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAC, 287.58
SCHERER PLUMBING WATER METER RESIDENTIAL HORN 86.64
4�20 85TH STREET
DELANO, MN 55328- TOTAL 374.22
(763)972-8137
Minnesota State License#: 62236 PM
OWNER
BRIGGS, MATTHEW& AL[SSA
1985 FAGERNESS PT RD
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for ti�hich this permit is issued shall be perfonned according to
the approvcd plans and specifications,applicable Cit��approvals,and thc
Slate 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 goveming this type of work
� shall be compied with whether or not specitied herein.This pennit will
expire and become null and void if construc[ion authorized is not
commenced within I 80 days of Uie date of issuance,or if construction is
suspended for a period of 180 days at any time atter work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conYonnance with the State Building Code.'I�his permit may be
revoked at any time for due cause.
�'����� � G Lva �l ��j'i �C�7 �/
Ap�t Permitec Signature Date Iss [3y Signature Date
SEPARATE PERMITS REQU[RED FOR WORK OTHER THAN DESCRIBED ABOVE.
a . �
F C Y USE ONLY
��0�� City of Orono 2//
�1 ¢ �� P.O.Box 66 Date Received /� Permit# aa� r ��J�
�/ ' '� �' 2750 Kelley Parkway
(� ».... .,.
)j�.'x;" II Crystal Bay,MN 55323 Approved By:(IfRequired):
\�?�'-"'r-�i•�,� (952)249-4600 .
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CITY OF ORONO-WATER METER FORM
(*Note:Some pennits 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. Ifpossible, 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�� ��q�+r�s ����,.�' �oc�
Owner: /" I ��".� Q a:G 9S Mailing Address:
City: U ro y,,b Zip: � � ���
Home Phone: Alternate Phone:
Contractor Information:
Contractor: ���'� �rv��,l� Contact Person: � ��-��
J
Address: y'SZv �� rS-f-r� �5tate License #: ���(Q ��
City: Zip: / '""' Expiration Date: ��-" 3/- /�
Phone: 7�3 "5'�1 ��37 Alternate Phone: �a' �3�- �'S%�'
4 . �+
WATER METER PERMIT FEES
WILL BE CAULULATED BY CITY STAFF
❑ 5/8"METER- ,�3/4" METER- � 1" METER-
� 5/8"HORN - �3/4"HORN - � 1"HORN -
� "WATER METER (THESE WILL HAVE TO BE SPECIAL ORDERED&PRICES DETEIL�VIINED)
1. METER FEE: $ � � / •�J U
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" �/4" ❑ 1" ❑ Other "
SERIAL#: ��'J � `55 (p� � 7
ERT HIGH#: _ IIIIIIIIII8208I�I�I4IIIIII ( PP , )
if a hcable
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: �" � J��`'J Date: ���--
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Original: I-Arldress File
Make Copies For: I- Utilrry Billing Depm�h�lent I-Cash Drawe�-