HomeMy WebLinkAbout2014-00165 - water meter - CITY OF ORONO
* 2014 - 00165 *
2750 KELLEY PARKWAY DATE ISSUED: 02/28/2014
ORONO, MN 55356-
952) 249-4600 FAX: 952 249-4616
ADDRESS 3740 TOGO RD
PIN : 17-117-23-31-0023
LEGAL DESC TOWNSITE OF LANGDON PARK
LOT 000 BLOCK 010
PERMIT TYPE WATER METER-RESIDENTIAL
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE WATER METER-RESIDENTIAL
NOTE: INSEPCTIONS ARE DONE BY PUBLIC WORKS DEPARTMENT.
TO SET-UP AN INSPECTION,PLEASE CALL:(952)249-4613
NEW 5/8" METER
SERIAL#94069740
IRT HIGH# 1850417344
WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 245.70
EMERY, DARYL&KRISTI Payment(s) TOTAL 245.70
3740 TOGO RD CREDIT CARD 0314 245.70
WAYZATA, MN 55391-
OWNER
EMERY, DARYL&KRISTI
3740 TOGO 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 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 180 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
Appli t P rtni e Signature Date Issued Signature Date
V
F R C USE ONLY
�O A T City of Orono ei �f /
1 V P.O.Box 66 date Receid� � Permit#VC.Q v'� ✓1�—"
0 2750 Kelley Parkway
Crystal Bay,MN 55323 Approved By:(If Required): O
(952)249-4600 4 ��'
` kESH0 CITY OF ORONO WATER METER FORM
(*Note:Some permits may require approval by the Building Official and/or Public Works Department
s)
GENERAL INFORMATION
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 meter installation.
TYPE OF PERMIT
(Cheek All That Apply)
Residential(May Require Approval) ❑ Commercial(Approval Required)
❑ New Meter ❑Additional Meter–For: ❑ Replacement Meter
JobSite/ Owner Information:
Site Address: ✓ / O °
c o c f
Owner: Mailing Address: °
City: Zip:
Home Phone: �I�2 '`f �'qU "7 " 1 Alternate Phone: l.�tZ' 3 D'Jo'y44
Contractor Information:
Contractor: Contact Person:
Address: State License#:
City: Zip: Expiration Date:
Phone: Alternate Phone:
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) $
CITY-USE ONLY
* For Current Pricing Refer to Current Year- Water Meter Pricing Chart
BRAND: p-� G /r^
SIZE: 14 5/8" ❑ 3/4" El I" El Other IRI 0 17 7 � `—7/1c
SERIAL#: { �D� / 7 LID
ERT HIGH#: 1 Ow 41 —7 3 (if applicable) ( v,
III III IN 111 IN 111111111111
1850417344
ADijI I IUNAL INFORMATION—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.
Applicants, Date:
Original: ]-Address File
Make Copies For: 1- Utility Billing Department 1-Cash Drawer