HomeMy WebLinkAbout2013 - 00992 - water meter '^.11111 II1111 II II 1111111 111
CITY OF ORONO * 2 0 1 - 00J 9 9 2
2750 KELLEY PARKWAY DATE ISSUED: 09/25/2013
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 2630 WEST LAFAYETTE RD
PIN : 21-117-23-24-0044
LEGAL DESC : SHORE HILLS
: LOT 000 BLOCK 000
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
THIS PERMIT IS FOR 5/8"HORNS ONLY-NOT A METER
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 0
APPLICANT
DENNIS WEDGE WATER METER RESIDENTIAL 0.00
614 THIRD AVE SW WATER METER RESIDENTIAL HORN 68.97
HUTCHINSON, MN 55350 TOTAL 68.97
(612)801-5260
OWNER
ETAL,THOMAS LOWE
2630 WEST LAFAYETTE RD
EXCELSIOR,MN 55331
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.
/ / 9/2 ��/3
Applicant Permitee Signature Date Issued y Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
$ 0%9
FOR CITY USE ONLY
O City of Orono
P.O.Box 66
�� 2750.Kelley Parkway
oto...
Crystal Bay,MN 55323 Approved By:(If Required):
(952)249-4600 Date Received: Permit#
1.
`� CITY OF ORONO-WATER METER FORM
`�xES H0°'
(*Note:Some 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)
I'Residential(May Require Approval) ❑ Commercial(Approval Required)
❑ New Meter ❑Additional Meter—For: ❑ Replacement Meter
Job Site/ Owner Information:
Site Address: Z e:::3 c) 2 . 1-...fi=g ` e--
Owner: Mailing Address:
City: (-2k-a.r.. Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor: ------ --kr,�ts Lk--)e-c. .:..)0____ Contact Person:-t,..,,..5 U) �e-
Address: (4:t`\ 3 r4Y Roe, S, ..e.)• State License#: P r\.c" tot Sf
City: ` v. -,v ..9,-,• Zip:SS3 Expiration Date:
Phone: (4,--1L- %D t- S z c,O Alternate Phone:
, v i
WATER METER P + y T FEES a a, a
WILL BE'!CAULULATED BY CITY STAFF. ,. ; ';
❑ 5/8"METER- ❑ 3/4"METER- ❑ 1"METER-
0 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) $ (IU 1 ` 7
CITY-USE ONLY
* For Current Pricing Refer to Current Year - Water Meter Pricing Chart *
BRAND:
SIZE: k110/8" ❑ 3/4" ❑ 1" ❑ Other "
SERIAL#:
ERT HIGH#: (if applicable)
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.
--111 Applicant: -— Date: c--1- z------ l3
Original: 1-Address File
Make Copies For: I- Utility Billing Department 1-Cash Drawer