HomeMy WebLinkAbout2008-00429 - water meter CITY OF ORONO PERMIT NO.: 2oos-oo429
2750 KELLEY PARKWAY
.
• ORONO,MN 55356- DATE ISSUED: 12/03/2008
952 249-4600 FAX: 952 249-4616
ADDRESS : 3768 NORTH SHORE DR
PIN : 08-117-23-34-0063
LEGAL DESC : N/A
: LOT 000 BLOCK 000
PERMIT TYPE : WATER METER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER METER
NOTE: INSPECTIONS 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
ROBERT BEISSEL HOMES WATER METER RESIDENTIAL HORN 61.00
1718 EAGLE LANE TOTAL 373.40
MOLJND,MN 55364
(612)581-4254
Minnesota State License#:20043044
OWNER
BLAIR,NANCY
5501 VILLAGE DR
EDINA,MN 55439
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 sepazate
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 i formance with the te Building Code.This permit may be
revoked aE ime or due use.
� / � /� / /
A p cant Percrt'ee S�gnatur Date Issue y i nature Date
L��
SEPARATE PERMITS REQUIRED FOR WORK OTHER HAN DESCRIBE BOVE.
� _ �
-
FOR CITY'USE ONLY
Q,���O City of Orono
P.O.Box 66 Date Reeeived: Pennit#
2750 Kelley Parkway
�� ,- r Crystal Bay,MN 55323 Appmved By;�If Requiredj:
�0� (952)249-4600
CITY OF ORONO—WATER METER FORM
(*Note:Some permits may require approval by the Building Official and/or Public Works Department*)
GENERAL:INFQF.IVIATIOI�i '
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 lmow 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 Th�t A' 1
�Residential(May Require Approval) ❑Commercial(Approval Required)
❑ New Meter ❑Additional Meter—For: �Replacement Meter
Job Site/Owner Information:
Site Address: ��6g �. �� . � (�.
Owner:l►1����1 E �P,r�W p�� Mailing Address:
City: ��4 2�A- Zip: S53`� I
Home Phone: �s2-g��-09g� Alternate Phone: co��.- g�S- IOS�-
Contractor Informatian: `
Contractor: �:� �ss� � l.�c Contact Person: ¢..�� �SS�L
Address: �7�� �� Ln1 State License#: �7.��`7
City: (I�a�Nn Zip�,�,� Expiration Date: 3'3 i - O`�
Phone: 952-�7�-�(�g Alternate Phone: �o12-Sb'I � y�s�
C� �
❑ 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 DETERMINED)
L METER FEE: $ �loZ ,�O
2. HORN FEE $ �� , p�
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) $ �j�.3, `7�
CITY-USE ONLY
* For Current Pricing Refer to Current Year-Water Meter Pricing Chart*
BRAND:
SIZE: ❑5/8" ❑3/4" ❑ 1" ❑Other "
SERIAL#:
ERT HIGH#: (if applicable)
ADDITi�NAL TN�'ORMATIUN-WATER METEI�S
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 ce�fies that all statements made on this application are,true and conect.
� i
Applicant: �. 7 Date: ��-3-U�
j�i �,
Original: 1-Address File
Make Copies For: I- Utility Billing Depariment 1-Cash Drawer