HomeMy WebLinkAbout2017-00766 - water meter � - . CITY OF ORONO
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2750 KELLEY PARKWAY DATE ISSUED: 07/06/2017
ORONO,MN 55356-
(952 249-4600 FAX: (952 249-4616
ADDRESS : 2189 SHADYWOOD RD
PIN : 17-117-23-43-0137
LEGAL DESC : WILEYS PARK LAKE MTKA
: LOT 008 BLOCK 002
PERMIT TYPE : WATER METER-RESIDENTIAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER METER-RESIDENTIAL
ACTIVITY : 102-SINGLE FAMILY HOUSES,ATTACHED
NOTE: INSEPCTIONS ARE DONE BY PUBLIC WORKS DEPARTMENT.
TO SET-UP AN INSPECTION,PLEASE CALL:(952)249-4613
WATER METER 5/8= 1540087286 S/N 68566708
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 242.65
WATER METER RESIDENTIAL HORN 82.02
BIG SKY PLUMBING LLC TOTAL 324.67
927 SCOTT LANE
BELLE PLAINE,MN 56011- Payment(s)
(612)743-7917 CREDIT CARD 1553 324.67
Minnesota State License#:plbg-062467
OWNER
LARSON,THOMAS
2189 SHADYWOOD RD
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 dces
not grant permission for additional or related work which requires separate
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 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.
/ /
Applicant Permitee Signature Date Issued By Signature Date
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O Clty Of OCORO '
P.O.Box 66 #�13�iVed,;,,_,�„�ell�t��_,.,, ,
� �� 2750 Kelley Parkway
Crystal Bay,MN 55323 A�i�vc�i$3+:(tf�it�. '
(952)249-4600
�� �,�'� CITY OF ORONO-WATER METER FORM
�kESH�4 (Note:Some permits may require approval by the Building Official and/or Public Works Department)
GENE�L Ih1F'C7RM�TI(J�+1'`
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 completion of ineter installation.
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❑Residential(May Require Approval) ❑Commercial(Approval Required)
❑ New Meter ❑Additional Meter—For: �'Replacement Meter
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Site Address: � �� Gi �o�/ �
Owner:/f29�i�S La�'S0�✓ Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
+��tr�c�8r:C��rn��ii�:
Contractor: r Contact Person: ��`� ��C.��� �
��� � �� T 1�,,,a,i���� �c//�� G✓ ,Q,,,5 �e�/�j-
� Addres�: State License#: �S��d�_y�q�
City: Zip: Expiration Date:
Phone: �Tol- �y�- 7q I 7 Alternate Phone:
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❑ 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)
1. METER FEE: $
2. HORN FEE $
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) $
CTTY-USE ONLY
* For Current Pricing Refer to Current Year- Water Meter Pricing Chart *
BRAND:
SIZE: r sfe-x s�a ❑Other „
� f�850 08
SE�L#: ' IIIIIIInIh�UI �IIIIIII��
ERT HIGH#: (if applicable)
` AD�ITK}N�I,Il'�FO�MATION-��VA"I'�l� A�ETER�
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:
Original: 1-Address File
Make Copies For: 1- Utility Billing Department