HomeMy WebLinkAbout2015-01082 - water meter CITY OF ORONO * z 0 1 5 - 0 1 0 s z *
, ' 2750 KELLEY PARKWAY DATE ISSUED: 08/25/2015
� ORONO, MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 2598 CASCO POINT RD
PI N : 20-117-23-21-003 5
LEGAL DESC : NAVARRE WOODS
: LOT 002 BLOCK 001
PERMIT TYPE : WATER METER- RESIDENTIAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER METER HORN
NOTE: 5/8° METER HORN ONLY.
WATER METER RESIDENTIAL HORN 1
APPLICANT WATER METER RESIDENTIAL HORN 80.42
TOTAL 80.42
FITZGERALD, PATRICK& PAMELA Payment(s)
2598 CASCO PT RD CREDIT CARD 1585 80.42
WAYZATA, MN 55391-
OWNER
FITZGERALD, PATRICK& PAMELA
2598 CASCO PT 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
Sta[e Bui(ding Code. This permit is for only the work described and does
not gran[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 nuI►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
revo any �me for due c e. "
��-�'`� � -e�� � � z5, /�
ic t Permitee Sign e Date Issued Signature Date
FOR CITY USE ONLY
�O� City of Orono a� r� 1� ('� � /
O P.O.Box 66 Date Received: Pertnit# -J / b d
2750 Kelley Pazkway
Crystal Bay,MN 55323 Approved By:(IfRequired):
(952)249-4600
y`��.�kFs oR�.�'� CITY OF ORONO—WATER METER FORM
H (Note:Some permits may require approval by the Buildmg Official and/or Pubhc 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 ineter installation.
TYPE OF PERMIT
(Check All That Ap ly)
esidential(May Require Approval) ❑Commercial(Approval Required)
❑ New Meter ❑Additional Meter—For: ❑ Replacement Meter
Job Site/Owner Information:
c, n �
Site Address: � � l �S �S c'� �� �p � �1.�f���%�"7� �-�� �
� � �� 3 /( (
Owner: f L k t � _ ,����,�Nlailing Address: �
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor: Contact Person:
Address: State License #:
City: Zip: Expiration Date:
Phone: Alternate Phone:
WATER METER PERMIT FEES
WII.,L BE CAULULATED BY CITY STAFF
❑ 5/8"HORN - ❑ 3/4"HORNR- ❑ 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:
SIZE: ❑ 5/8" ❑ 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 certifies that 11 statements ade on this application are,true and correct.
� �5�ZO' I �.-�
App��cant - - � —�-Date: (� �
Original: 1-Address File
Make Copies For: 1- Utility Billing Department