HomeMy WebLinkAbout2015-00206 - water meter CITY OF ORONO * z p� 1 5 - 0 0 2 0 6 *
' , i 2750 KELLEY PARKWAY DATE ISSUED: 02/17/2015
ORONO, MN 55356-
(952 249-4600 FAX: 952 249-4616
ADDRESS : 3309 CRYSTAL BAY RD
PIN : 17-117-23-41-0016
LEGAL DESC : WALLACES ADDN TO VIL OF MTKA B
: LOT 001 BLOCK 000
PERMIT TYPE : WATER METER- RESIDENTIAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTIOIY TYPE : WATER METER- RESIDENTIAL
NOT�: INSI;PCTIONS nRE DONG BY PUBLIC WORKS DEPARTMEN"C.
TO SET-UP AN INSPECTION,PLEASE CALL:(952)249-4613
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 372.06
WATER METER RESIDENTIAL HORN 121.I 5
P.H. MECHANICAL INC MISC FEE 0.00
5056 SULGROVE RD
MOUND, MN 55364- TOTAL 493.21
(612)418-I 123 Payment(s)
CHECK 8901 493.21
OWNER
SCHMID, DAVID
3309 CRYSTAL BAY RD
WAYZATA, MN 55391-
AGREEMEIVT 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. 'Chis permit is for only the work described and does
not grant permission for additional or related work which requires separate
permi[s. All provisions of laws and ordinances governing[his 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 da[e of issuance,or if construction is
suspended for a period of l80 days at any[ime after work has commenced.
I'he applicant is responsible for assuring ali required inspections aze
requested i on rmance with the State Building Code.This permit may be
revoked any me for due cause
Q� , �'�7�1�t--� � // � i/ -S
/lpplicant Per � Signature Datc Issu E3y Signature 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):
(952)249-4600
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`�kESH���G CITY OF ORONO —WATER METER FORM
(Note:Some permits may require approval by the Building Ofticial and/or Public Works DepaRment)
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 Ap 1 )
OResidential(May Require Approval) ❑ Commercial(Approval Required)
�New Meter ❑ Additional Meter—For: ❑ Replacement Meter
Job Site /Owner Information:
Site Address: _5. �,' ` ��� �—� �G ��U•
V v'-_
Owner: �.��^tc� JC�,T,�r c.�� Mailing Address: �3�` � ��� ��
City: �,�'J vt,c�� Zip: �"��� �
Home Phone: Alternate Phone:
Contractor Information:
Contractor: {�•�, �����c�vt,c w-` Contact Person: ���� �-� lC V
Address: S�l� .5��(a .-�;v� ��� State License#: ��- E�`-I`{ c�L Z
City: � �v�� Zip:�'�.�6`/ Expiration Date: /�,2 -3I� /�
Phone: �.�.��I(�'-/I L.S� Alternate Phone:
WA'I'ER���ME"I'BR PERMIT FEES � �
� WILL BE CAULULATED BY CITY STAFF �
❑ 5/8"METER- ❑ 3/4"METER- [� 1" METER-
❑ 5/8"HORN - ❑ 3/4"HORN - .[� 1"HORN -
❑ " WATER METER (THESE WILL HAVE TO BE SPECIAL ORDEREU&PRICES DETERMINED)
1. METER FEE: $
2. HORN FEE $
3. TOTAL PERMIT FEE (Add Lines ]-2 Above) $ �� �'
CITY-USE ONLY
* For Current Pricing Refer to Current Year - Water Meter Pricing Chart *
BRAND: I V �1�'e�
SIZE: ❑ 5/8" ❑ 3/4" � 1" ❑ Other "
SERIAL#: 5 3 � 9 3� � �
ERT HIGH#: III III III III III I II II IIII II III (if applicable)
1852509549
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, an e ifies that all statements made on this application are,true and correct.
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Applicant: � C���� Date: �—' �� –� S
Origina[: 1-Address File
Make Copies For: 1- Utility Billing Department