HomeMy WebLinkAbout2014-00547 - water meter , CITY OF ORONO * Z 0 1 4 - 0 0 5 4 7 *
2750 KELLEY PARKWAY DATE ISSUED: 06/03/2014
. ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 105 CREEK RIDGE PASS
P[N : 03-117-23-12-0012
LEGAL DESC : CREEKSIDE IN ORONO
: LOT 001 BLOCK 001
PERMIT TYPE : WATER METER -RESIDENTIAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER METER- RESIDENTIAL
NOTF,: INSEPCT[ONS nRE DONE BY PUBLIC WORKS DEPAR"1'MEN'1�.
TO SET-UP AN INSPECTION,P1,EASE CALL:(952)249-4613
1" WATF,R METER
SERIAL NUMI3ER 52648043
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WA"I'ER METER RESIDENTIAL 392.92
WATER METER RESIDENTIAL HORN 104.45
KRG PLUMBING INC MISC FEE 0.00
1 168 IFFERT AVE SE
BUFFALO, MN 55313- TOTAL 497.37
(612)282-5041 Payment(s)
Minnesota State License#: plbg-609777 CREDIT CARD 5600 497.37
OWNER
ROBIN,JOHN &CYNTHIA
5925 FIELDSTONE PLACE
INDEPENDENCE, MN 55359-
AGREEMENT AND SWORN STATEMENT
I�he work for which this permit is issued shall be perfom�ed according to
the approved plans and specitications,applicable City approvals,and the
State F3uilding Code. "I'his pemiit is for only the work described and does
not grant permission for additional or related work which requires separate
permits. All provisioi�s of laws and ordinances governing this type of work
shall be eompied with whether or not specified herein.This permit will
expire and become null and void if constniction 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 eommenced.
"l�he 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 eause.
_ _ - _ �/���Zc�l �;� � i i
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A icant ermitee Signature Date Issued F3y ature Date
' FOR CITY USE ONLY
�O�O City of Orono
P.O.Box 66 Date Received: Permit#
2750 Kelley Parkway
Crystal Bay,MN 55323 Approved By:(If Required):
(9�2)249-4600
� �
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`�� ��'� CITY OF ORONO —WATER METER FORM
�KES H�� (*Note:Some permits may require approval by the Building Official and/or Public Works Department
*�
GENERAL INFORMATION
l. 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 A ly)
❑ Residential (May Require Approval) ❑ Commercial(Approvai Required)
❑ New Meter ❑ Additional Meter—For: ❑ Replacement Meter
Job Site / Owner Information:
�
Site Address: �O5 ���� �'`S-�
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor: 11 �� �� Y✓ Contact Person: �I��
Address: / �X �t�e License #: �/J � �7 � /
City: � Zip: Expiration Date:
Phone: ���1 - �$�t' S� �� Alternate Phone:
.
WATER METER PERMIT FEES
WILL BE CAULULATED BY CITY STAFF
❑ 5/8" METER- ❑ 3/4" METER- " METER-
❑ 5/8"HORI�' - ❑ 3/4" HORN - "HORN -
❑ " WATER METER (THESE WILL HAVE TO BE SPECIAL ORDERED&PRICES DETERMINED)
1. METER FEE: $�-�9� ,Gf�
2. HORN FEE $ �O y yS
3. TOTAL PERMIT FEE(Add Lines I-2 Above) $ `� � /. � �
� CITY-USE ONLY
* For Current Pricing Refer to Current Year - Water Meter Pricing Chart *
BRAND: DV�TGc�'�
SIZE: ❑ 5/8" ❑ 3/4" [�:1" ❑ Other "
SERIAL#: s''�P� � T�
ERT HIGH#: I O ��� Y'�} � �5 �I�������I II��I�����I�����I��
1834344489
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.
. �___ "
_. _ _ �l�/�di�
Applicant: __� Date:
Original.• 1-Address File
Make Copies For: 1- Utilrty Billing Department I-Cash Drawer