HomeMy WebLinkAbout2008-00449 - water meter CITY OF ORONO PERMIT NO.: 2008-00449
� 2750 KELLEY PARKWAY
ORONO,MN 55356- DATE ISSUED: 12/15/2008
. 952 249-4600 FAX: 952 249-4616
REPRINTED ON 12/15/2008
ADDRESS : 3534 IVY PL
PIN : 20-117-23-42-0019
LEGAL DESC : TAYLORS SUBD OF SPRING PARK LO
: LOT 000 BLOCK 000
PERMIT TYPE : WATER METER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER METER
NOTE: INSEPCTIONS ARE DONE BY PUBLIC WORKS DEPARTMENT.
TO SET-UP AN INSPECTION,PLEASE CALL:(952)249-4613
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 312.40
VICTORIA PLUMBING WATER METER RESIDENTIAL HORN 61.00
1855 WEST 80TH ST
P.O.BOX 174 TOTAL 373.40
VICTORIA,MN 55386
(952)443-0034
Minnesota State License#: 005584PM
OWNER
DANBERRY
3534 IVY PL
WAYZATA,MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this permit is issued shall be performed according to
the approved plans and specifications,applicable Ciry 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 sepazate
permits. All provisions of laws and ordinances goveming 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 afrer work has commenced.
The applicant is responsible for assuring all required inspections aze
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
/ / / /
Applicant Permitee Signature Date Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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����0 City of Orono
P.O.Box 66 Datc Receivod: ' Pertttit#'
2750 Kelley Pazkway
� '' r ' Crystal Bay,MN 55323 A�pmved T3y:(IfICet�uiredj'€
�` be (952)249-4600
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CITY OF ORONO—WATER METER FORM
(*Note:Some permits may require approval by the Building Official and/or Public Works Department*)
:CxENERAL ZNFOR1vIATIC.��+t
1. WATER METERS must be picked up and paid for at City Hall.
2. If nossible,faac in this application ahead of time;we will then call you and let you lrnow 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 fJ�PERMIT
Checl�AIl That A 1
❑Residential(May Require Approval) ❑Commercial(Approval Required)
❑New Meter ❑Additional Meter—For: �Replacement Meter
Job Si�e f�wner Inf'ormatic�n:
Site Address: 3-5�� �L lJ�/ ��G�Cr�
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Co�iractor Tnformati4n: i
Contractor: V l^L �P i t,. �U/'1�% Contact Person: (Jb L r,J�7Gt h N�
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A d d r e s s: ��`����7 4 S t a t e L i c e n s e#: b v�
City: ��'� r� Zip:/` Expiration Date: �Z' _��— ��
Phone: �Z ��� �.3�- Alternate Phone: (�Z �CCG ' Z�S7
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WATER METER PERMIT FLES
WILL BE CAULULATED BY CITY STAFF
❑ 5/8"METER- � 3/4"METER- � 1"METER-
� 5/8"HORN - �] 3/4"HORN - ❑ 1"HORN -
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❑ "WATER METER (THESE WILL HAVE TO BE SPECIAL ORDERED&PRICES DETERMINED)
1. METER FEE: $ � -'� :� ' ����
2. HORN FEE $ �l, I � QL�
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) $ ����� T � - ���;
CITY-USE ONLY
* For Current Pricing Refer to Current Year- Water Meter Pricing Chart *
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BRAND: u' �_��� —C� � t
SIZE: ❑ 5/8" ?�] 3/4" ❑ 1" ❑ Other "
SERIAL#: � �'� �" 7 ����� 1
ERT HIGH#: �. III��I���������������I�I I�I II (if applicable)
1810045112
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 e ordinances of the City and the regulations of the State
of Minnesota, and cer 'fie that al s t nts made on this application are, true and correct.
Applicant: Date: ��"" ��^� �
Reset Form
Original: I-Adc�ress File
Make Copies For: 1- Utiliry Billing Department 1- Cash Drawer