HomeMy WebLinkAbout2011-01130 - water meter '" —��� CITY OF ORONO PERMIT NO.: 2011-01130
2750 KELLEY PARKWAY
ORONO, MN 55356- �ATE Iss[1En: 09/28/2011
952 249-4600 FAX: 952 249-4616
ADDRESS : 2330 GLENDALE COVE LA
PIN : 34-118-23-33-0063
LEGAL DESC : GLENDALE COVE
: LOT 004 BLOCK 001
PERMIT TYPE : WATER METER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER METER
NOTE: INSEPCTIONS ARE DONG I3Y PUBLIC WORKS DEPARTMENT.
TO SET-UP AN INSPECTION,PLEASE CALL: (952)249-4613
5/8"NE PTUNL WATER ME1'F R-SERIAL NUMBER-90496199
ERT I-IIGH# 1831769194
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENT[AL 245.70
AMERICAN MECHANICAL CO, INC. WATER METER RESIDENTIAL HORN 68.97
7120 71ST AVE.N.
PO BOX 205 MISC FEE 0.00
LORETTO, MN 55357- TOTAL 314.67
(612)750-0278 PA[D W1TH CC# 9327
Minnesota State License#: 065381 PM
OWNER
RHOADS,NICK&JENNY
140 CARLSON PKWY#308
MINNETONKA,MN 55345-
AGREEMENT AND SWORN STATEMENT
'I'he work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and thc
State Building Code. This permit is for only the Hark described and does
not grant permission for additional or related work which requires separate
permits. All provisions of laws and ordinanccs governing this type of work
shall be compied with whether 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 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspec[ions are
requested in conti�rmance with the State Building Code.This permit may be
r �ed any im for due caus /`�� / � I �
Applicant Permite�Signature Date � � / ��/ /
Iss y Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
FOR ITY SE ONLY
�rj�'�� City of Orono ��j J/„ ���(�
��� � �� P.O.Box 66 Date Received� �Permit#
��, , ��' 2750 Kelley Parkway
���� �j����`r.'- ��� Crystal Bay,MN 55323 Approved By:(I£Required):
�\�:p�:,.�`o� (952)249-4600
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CITY OF ORONO—WATER METER FORM
(*Nate: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 comptetion of ineter installation.
TYPE OF PERMIT
Check All That A 1
� Residentiai (May Require Approval) ❑ Commercial (Approval Required)
� New Meter � Additional Meter—For: � Replacement Meter
Job Site /Owner Information:
Site Address: ��J� ��������� �j V �
Owner: Mailing Address:
City: ���'U � Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor: ��G� /�'(�� Contact Person: ►I�� ��\U ��
Address: State License#: �(�5��� � '�/"I
City: 1������L� Zip�7b Expiration Date:
Phone: �'�� SCl'-'�7� Alternate Phone:
_ _ , •
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 DETERh11NED)
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 *
B�,ND: �J.�p�u��
SIZE: [�5/8" ❑ 3/4" ❑ 1" ❑Other "
SERIAL#: ��`�`/ � � / J
ERT HIGH#: IIIIII������������������I�III (if applicable)
1831169194
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 that all statements made on this application are,true and correct.
Applicant: '�' Date: � ��_ ' �
Reset Form
Or�igi�ial: /-A�fdress File
Make Copies Fo�•: 1- Utiliry Billing Depm�t»lent 1-Cash Dr�awer