HomeMy WebLinkAbout2015-01187 - water meter ti ''�` CITY OF ORONO
2750 KELLEY PARKWAY * DA�TE ISSUED: 9/6/015 *
ORONO,MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 1910 SHADYWOOD RD
pIri : 17-117-23-24-0020
LEGAL DESC : SHADY-WOOD
: LOT 031 BLOCK 000
PERMTT TYPE : WATER METER-RESIDENTIAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER METER HORN
NOTE: 5/8"METER HORNS ONLY
WATER METER RESIDENTIAL HORN 1
APPLICANT WATER METER RESIDENTIAL HORN 80.42
TOTAL 80.42
KRAHL'S PLUMB Payment(s)
3508 LYRIC AVE CREDIT CARD 8243 80.42
WAYZATA,MN 55391-
OWNER
MCMANUS,JAMES&MEGAN
1910 SHADYWOOD RD
WAYZATA,MN 55391-
AGREEMENT AND SWORN STATEMENT
The work for which this pertnit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. 1'his 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 construction is
suspended for a period of I80 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.1'his pertnit may be
revoked at any time for due cause.
/ /
Applicant Permitee Signature Date Issued By Signature Date
� . .
R C.. L�OAl.Y
�A TO City of Orono
<V P.O.Box 66 D�e Ree�ived: P�it#
2750 Kelley Parkway
Crystal Bay,MN 55323 t�t�wed�y:(I�'�ir�:
(952)249-4600
�`�� �.�� CITY OF ORONO—WATER METER FORM
�kES H�� (Nate:Some permits may require approval by the Building Official and/or Public Works Department)
GE1�tE�AL II�FO�IVIATION
1. WATER METERS must be picked up and paid for at City Hall.
2. If�ossible,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.
' T''YP�C�F':P�R�II'�'
��k All'T'�A
❑Residential(May Require Approval) ❑Commercial(Approval Required)
❑ New Meter ❑Additional Meter—For: ❑Replacement Meter
Job S�te/Ov�r i�nr.r�ati4�: ;
Site Address:
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Cot��ra�to�Ir�o�tian:
�,K ���
Contractor: r t�+�9 Contact Person: ��
Address: �s� ���� State License#:
City: ���tt'� Zip:� Expiration Date:
. 3`'1�
Phone: l 73�' Alternate Phone:
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y'� 't : y Y�..
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pt'' A', � h �, �� = � •� �' �r ,� �'S�.�r�" ��r�is'.. ,
°A�%:yy N iv'Y"s ��' R»�' 4r , �� _ ,iY> e.�k�.
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❑ 5/8"HORN - ❑ 3/4"HORN - ❑ 1„HORN -
"WATER METER (THESE WILL HAVE TO BE SPECIAL ORDERED&PRICES DETERMINED)
1. METER FEE: $
2. HORN FEE $ �
3. T PERMIT FEE(Add Lines 1-2 Above) $ � �" �/
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)
ADI)iTIflNAL INFOR1ViATION-WATER I�ETERS
The undersigned hereby applies to the Ci of Orono for issuance of a water meter permit, agrees
to do all work in strict cc rda e with th rdinances of the City and the regulations of the State
of Minnesota, and certi s at a sta e m e on this application are,true and correct.
, � r,a i
Applicant:
Date: � ��/ �
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Original: 1-Address File
Make Copies For: 1- Utility Billing Department