HomeMy WebLinkAbout2015-00536 - water meter horn CITY OF ORONO * 2 0 1 5 - 0 PJ 5 3 6 *
„ � 2750 KELLEY PARKWAY DATE ISSUED: OS/OS/2015
ORONO, MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 2715 CASCO POINT RD
PIN : 20-117-23-23-0005
LEGAL DESC : AUDITOR'S SUBD.NO.265
: LOT 005 BLOCK 000
PERMIT TYPE : WATER METER- RESIDENTIAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER METER HORN
NOTE: INSEPCTIONS ARE DONE BY PUBLIC WORKS DEPARTMENT.
TO SET-UP AN INSPECTION,PLEASE CALL:(952)249-4613
(5/8 METER HORN REPLACEMENT)
WATER METER RESIDENTIAL HORN 1
APPLICANT WATER METER RESIDENTIAL HORN 80.42
TOTAL 80.42
CITY VIEW PLUMBING&HEATING Payment(s)
1880 WAYZATA BLVD W CHECK 35310 80.42
P.O. BOX 150
LONG LAKE,MN 55356
(952)473-8793
Minnesota State License#: plbg-MB005208
OWIVER
JLJNGELS,KEITH
4612 DEXTER AVE
EDINA,MN 55424-
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 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 l80 days at any time after work has commenced.
e applicant is responsible for assuring all required inspections are
reque in conformance ' the State Buildin ode.This permit may be
evoked a y time for du cause.
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App ' e itee Signature ate Issued By Signature Date
. •
FOR CI1'Y USE ONLY
City of Orono �
_.- ,;y,.�� . � ,
���� P.O.Box 66 Date Received:L�ermit# -- ' .��
2750 Kclley Parkway �� . �`
Crystal Bay,MN 55323 Approved By:Qf Required): �
(952)249-4600
yF �,� �'��iS 7� o�/d l�of'
�q �, CITY OF ORONO —WATER METER FORM /� ,,,.�
kESH�� (Note:Some permits may require approval by the Building Official and/or Public Works Depa�r r��
,c��f-/iN1 •
GENERAL INFORMATION
L WATER METERS must be picked up and paid for at City Hall.
2. If nossible, 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 A 1 )
❑ Residential(May Require Approval) ❑ Commercial(Approval Required)
❑ New Meter ❑ Additional Meter—For: ❑ Replacement Meter
Job Site/ Owner Information:
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Site Address: � � �9-
Owner: � Mailing Address:
�n �
City: ��l C��(� Zip: �
Home Phone: Alternate Phone:
Contractor Information:
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Contractor: �'1 '\ % �t,LitVj'Contact Person: �i'�`'�� �' `S�
Address: State License #:
City: Zip: Expiration Date:
`
Phone: Alternate Phone:
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WA"I'ER METER PERMIT FEES
W1I,L BE CAULULATED BY CITY STAFF
❑ 5/8" I1�E�-=-� ❑ 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 $ �G ' `"
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 1 w in strict ac dance with t e ordinances of the City and the regulations of the State
of Min esota, d certifi s that all state ents made on this application are,true and correct.
,.
Applican •" Date: 5��/ !�+
Original: 1-Address File
Make Copies For: 1- Utility Billing Department