HomeMy WebLinkAbout2010-00002 - water meter ~ • CITY OF ORONO PERMIT NO.: 2010-00002
2750 KELLEY YARKWAY
ORONO, MN 55356- DATE ISSUED: O1/04/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 3369 CRYSTAL BAY RD
PIN : 17-117-23-44-0017
LEGAL DESC : WALLACES ADDN TO VIL OF MTKA B
: LOT 014 BLOCK 000
PERMIT TYPE : WATER METER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER METER
NOTE: INSEPCTIONS ARE DONL-' E3Y PUBI,IC WORKS DEPARTMF,N C.
TO SGT-UP AN INSPECTION, PLEASE CALL:(952)249-4613
�/8" WATER METGR
SGRIAL# 86055�63
ER"C I IIGE 1 1830474967
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPWCANT
WATER METER RESIDENTIAL 268.05
HAGEN, PAUL WATER METER RESIDENT[AL HORN 66.83
3369 CRYSTAL BAY RD
WAYZATA, MN 55391 TOTAL 334.88
PAID WITH CASH 334.88
OWNER
HAGEN, PAUL
3369 CRYSTAL BAY RD
WAYZATA, MN 55391
AGREEMENT AND SWORN STATEMENT
The work for which this pennit is issued shall bc performed accordin�to
the approved plans and specitications,applicable City approvals,and the
State Building Code. This pennit is for only the work described and does
not grant permission for additional or related work which rcquires separate
pem�its. All provisions of laws and ordinanccs�overning this type of work
shall be compied with whether or not specified hcrein."I'his perniit will
expire and become null and void if construction authorized is not
commenced within 180 days of the date of issuancc,or if construction is
suspended for a period oY 180 days at any time atter work has commenced.
The applicant is responsible for assurin�all required inspections are
requested onforman with the Statc[3uilding Code.'I'his permit may be
revok a ny[ime f ue cause.
i i Q l'�_ �i i �O/v
pp c t er ee Signature Da e Issu d[3y Signature Date
SEPARATE PERMITS REQUIRED FOR WORK THER THAN DESCRIBED ABOVE.
. •
FOR C1TY USE ONLY
,��� City of Orono
P.O.Box 66 Date Received: Permit#
�°` � 2750 Kelley Parkway �
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a ���'�!;�'- a.� Crystal Bay,MN 55323 Approved By:(If Required):
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\�y,�,;��r,,��o (952)249-4600
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CITY OF ORONO—WATER METER FORM
(*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�ossible, 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 VVater Department (952) 249-4600,
upon completion of ineter installation.
TYPE�OF PERMIT
(Check All That A ply)
❑ Residential(May Require Approval) ❑ Commercial(Approval Required)
❑ New Meter ❑ Additional Meter—For: ❑ Replacement Meter
Job Site / Owner Information:
Z3 L � ��� ��` l�'�,�-��/,
Site Address: , > %��
'T -�
Owne .J �G— � f�� Mailing Address:
City: ���'j}��/ Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor: Contact Person: �
Address: State License #:
City: Zip: Expiration Date:
Phone: Alternate Phone:
, ,
WATER METER PERMIT FEES ;
WILL BE CAULlJLATED 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 SPEC(AL 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: �)'e.,��I/l.✓L �
SIZE: �5/8" ❑ 3/4" ❑ 1" ❑ Other "
SERIAL#: � �P O �j S S (0 7j
ERT HIGH#: ��������18���41149�fi7������ (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 Minnesot d certifies tha 11 statements made on this application are, true and correct.
Applic nt� Date:� � �- ����
� �
Original: I-Address File
Make Copies For: 1- Utilitv Billing Department 1- Cash Drawer