HomeMy WebLinkAbout2009-00027 - water meter ' • CITY OF ORONO PERMIT NO.: 2009-0002�
2750 KELLEY PARKWAY
ORONO,MN 55356- DATE ISSUED: 02/10/2009
952 249-4600 FAX: 952 249-4616
ADDRESS : 3443 LNINGSTON AVE
PIN : 17-117-23-43-0064
LEGAL DESC : NAVARRE HEIGHTS
: LOT 006 BLOCK 005
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
5/8" WATER METER-SERIAL#83161124,ERT# 1810248770
WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 259.40
BENJAMIN FRANKLIN PLUMBING TOTAL 259.40
1424 3RD STREET N
MINNEAPOLIS,MN 55411-
(763)755-6468
Minnesota State License#:M4004
OWNER
HEGER,DENNIS
3443 LIVINGSTON AVE
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 City 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 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 become null and void if construction authorized is not
commenced within 180 days of the date of issuance,or if consWction is
suspended for a period of 180 days at any time after 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.
/ / � �/ �d/ � �
Applicant Permitee Signature Date Issue y Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
FOR Ct�'Y USE ONLY
� City of Orono �
O¢ �O P•O.Box 66 Date Recei�ed: �0 Permit#� ���"' 0 a�
2750 Kelley Parkway
� ��, ;,`� Crysta]Bay,MN 55323 Approved By:(IfRequired):
�� (952)249-4600
�09
CITY OF ORONO—WATER METER FORM
(*Note:Some permits may require approval by the Building Official and/or Public Works Deparhnent*)
GENERAI,INFO'RMATION '
1. WATER METERS must be picked up and paid for at City Hall.
2. If nossible,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 Al1t'That A. 1 `
❑Residential(May Require Approvai) ❑ Commercial(Approval Required)
❑ New Meter ❑Addirional Meter—For: [�Replacement Meter
7ob �ite/Owner Inforrnatian: '
Site Address: 3 �J V 1 �S�V�, �}V�h,l,� rt',
Owner: �-�►�I. � �1� Mailing Address: .� 7-'-i3 �! 1/( J� 5�1 ��/�,
V
c�ty: zip: ��r' 3q 1
Home Phone: Alternate Phone:
Contractor Tnfornzation:
C ccv l cJ �-S a✓� S �/�
Contractor: �e�� aK•crti. F'�vt�c.�t�-�, Contact Person: / "��l�-
Address: �`�2`� � ' 3� 5t �� State License#: /"C ��T
I /
City: `� Zip� y�� Expiration Date:
Phone: �� �ss �o��g Alternate Phone:
� ,� , �.
5/8"METER- ❑ 3/4"METER- ❑ 1"METER-
5/8"HORN - ❑ 3/4"HORN - ❑ 1"HORN -
❑ "WATER METER ('I'HESE WILL HAVE TO BE SPECIAL ORDERED&PRICES DETERMINED)
1. METER FEE: $ p�S�j• �j
2. HORN FEE $ —
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) $ � S g. ��
CITY-USE ONLY
* For Current Pricing Refer to Current Year- Water Meter Pricing Chart *
BitarrD: ��P D`�U�'1
SIZE: �5/8" ❑3/4" ❑ 1" ❑Other "
SERIAL#: � �I�p 1� ��-
ERT HIGH#: ��IIII'I8I'I�N�III�IIIIII (if applicable)
ADDITIONAL INFORMAT�ON`=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: � �p
Original.• 1-Address File
Make Copies For: 1- Utility Billing Department 1- Cash Drawer