HomeMy WebLinkAbout2009-00016 - water meter CITY OF ORONO PERMIT NO.: 2009-00016
2750 KELLEY PARKWAY
" ORONO, MN 55356- �ATE �SSUED: OU30/2009
� 952 249-4600 FAX: 952 249-4616
REPRINTED ON 1/30/2009
ADDRESS : 85 FERNDALE RD N
PIN : 36-118-23-44-0005
LEGAL DESC : ALLO-RAE TERRACE
: LOT 001 BLOCK 001
PERMIT TYPE : WATER METER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER METER
NOTE: INSEPCTIONS ARE DONE BY PUBL[C WORKS DEPARTMGNT.
TO SET-UP AN INSPECTION, PLEASF CALL:(952)249-4613
NEW 3/4"WA'1'FR MET�R-(METER LEAKING) SI�RIAL#51547269, F.RT H1GH- 1820811761
WATER METER RESIDENTIAL 1
APPLICANT WATER METER RES[DENTIAL 312.40
CHERMAK, TONY TOTAL 312.40
85 FERNDA[,E RD N
WAYZATA, MN 55391
OWNER
CHERMAK, TONY
85 FERNDALE RD N
WAYZATA, MN 55391
AGREEMENT AND SWORN STATEMENT
The ti�ork for��hich this permit is issued shall be perfonned according to
thc approved plans and specilications,applicable City approvals,and the
State Building Code. This pcnnit 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 of work
shall be compied with whether or not specified herein.This permit will
expire and bccome null and void if construction authorized is not
commenced within 180 days of tl�e date of issuance,or if construction is
suspended for a period of 180 days at any time after work has commenced.
"I�he applicant is responsible for assuring all rcquired inspections are
requested in conformance with the State I3uildinc Code.This permit may be
revoked at any time for due cause.
/ / / /
Applicant Permitee Signature Date Issucd 13y S ature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DES D ABOVE.
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FOR CITY USE ONLY
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fO r` Q\ P•O.Box 66 Date Received: Permit#
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CITY OF ORONO—WATER METER FORM
(*1\ote:Some permits may requirc 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 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 �
❑Kesidential (May Require Approval) ❑ Commercial (Approval Required)
❑ New Meter � Additional Meter—For: �Replacement Meter
Job Site/Owner Information:
Site Address: �� �'���''�`�' � - / `� •
Owner: ��f�� �i►"�✓W�G-�� �
Mailing Address:
City: �i�'�'�=� Zip: `� ��r'l �
Home Phone: _��L� ���'�?�� Alternate Phone: (� ��' ((���0 r ( ���
Contractor Information:
Contractor: Contact Person:
Address: State License #:
City: Zip: Expiration Date:
Phone: Alternate Phone:
i .
WATER METER PERMIT FEES
��� �� WILL BE CAULULAT�D BY�CITY STAFF
❑ 5/8"METER- 4"METER- � 1"METER-
❑ 5/8"HORN - 3/4"HORN - ❑ 1"HORN -
❑ "WATER METER (THESE WILL HAVE TO BE SPECIAL ORDERED&PRICES DETERMINED)
I. METER FEE: $ �/a, .�f�
2. HORN FEE g
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) $ �/;;�, 'j��
CITY-USE ONLY
* For Current Pricing Refer to Current Year- Water Meter Pricing Chart *
BRaND: �/e_;��r E��--
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SIZE: ❑ 5/8" `�3/4" ❑ 1" ❑ Other "
SERIAL#: .�/�� '7,��y
ERT HIGH#: ����������������������������� (if applicable)
1820811761
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 with the ordinances of the City and the regulations of the State
of Minnesota, and certifies t all statements made on this application are, true and correct.
�
Applicant: Date: � ��
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Reset Form
Original: 1-Address File
Make Copies For: 1- Utilitl�Billing Departmenl 1-Cash D�•awer