HomeMy WebLinkAbout2018-00033 - water meter h
CITY OF ORONO * 2018 - 00033 *
2750 KELLEY PARKWAY DATE ISSUED: 01/11/2018
ORONO,MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS 3265 SHADYWOOD CIR
PIN 20-117-23-11-0048
LEGAL DESC SHADYWOOD VILLAS
LOT 7 BLOCK 1
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
P NEPTUNE METER
SERIAL#53944764
ERT# 1545531706
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 372.06
WATER METER RESIDENTIAL HORN 144.64
KRG PLUMBING INC TOTAL 516.70
1168 IFFERT AVE SE Payment(s)
BUFFALO,MN 55313= CREDIT CARD 6188 516.70
(612)282-5041
Minnesota State License#:plbg-PC644046
OWNER
Charles Cudd LLC
15050 23RD AVE N
PLYMOUTH,MN 55441-
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 th tate Building Code.This permit may be
revoked at any time for due ca e
Applicant Permitee Signature Date Issu By Signature Date
>R CITY L➢.li%[lVi.Y
n A TO City Orono
P.O.Box
66 Dgft Received: Pit#
2750 Kelley Parkway
Crystal Bay,MN 55323 AWwmd By:(ifRetluirea):
(952)249-4600
`�kE SHO
IQ, CITY OF ORONO-WATER METER FORM
(Note:Some
(N permits may require approval by the Building Official and/or Public Works Department)
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
Check All That Apply)
,EgResidential(May Require Approval) ❑ Commercial(Approval Required)
ANew Meter ❑Additional Meter—For: ❑Replacement Meter
Jab Site/Owner Information:
Site Address: S kA(,j.4 L,,,&oN C, r—�_
owner:�'�w�-�� G.�w� Mailing Address: ✓l
City: Zip:
Home Phone: &r Z &S 9 / 3L- Alternate Phone:
Contractor Information:
Contractor: Contact Person:
Address: I 1(.0 �'�C-�cr .4uc: -,C- State License #: ac 60,490,f f.,
city: Zip: 3 Expiration Date: IZ-t l - 11
Phone: (o(Z- 'zoz-S 0`< ( Alternate Phone:
W� ,C".LINED BY Cfff
ai.
❑ 5/8"METER- ❑ 3/4"METER- I"METER-
[:1 5/8"HORN - ❑ 3/4"HORN - 1"HORN -
❑ "WATER METER (THESE WILL HAVE TO BE SPECIAL ORDERED&PRICES DETERMINED)
1. METER FEE: $ -ZZ
2. HORN FEE $ y
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) s ' 70
CITY-USE ONLY
* For Current Pricing Refer to Current Year- Water Meter Pricing Chart
�LIJ ED2'11RDG3 LUC
BRAND: _ y
SIZE: E] 5/8" ❑ 3/4" �'
Other 53944764 IIIIIIIIIIIII
I VKIP11I1141411
SERIAL#: 5J3 9yy 776- _7
ERT HIGH#: J � J 1707 4Q (if applicable) 151415531�70F
ADDITIONAL 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.
Applicant:
Date:
Original: 1-Address File
Make Copies For: 1- Utility Billing Department