HomeMy WebLinkAbout2013-00138 - water meter • CITY OF ORONO * z p� 1 3 - 0 0 1 3 8 *
2750 KELLEY PARKWAY DATE ISSUED: 02/25/2013
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 3443 CRYSTAL PL
PIN : 17-117-23-43-0005
LEGAL DESC : NAVARRE HEIGHTS
: LOT 002 BLOCK 002
PERMIT TYPE : WATER METER- RESIDENTIAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER METER- RESIDENTIAL
NOTE: INSEPC"['IOVS ARE;DONE BY PUBLlC WORKS DEPARTMENT.
TO SET-UP AN [NSPEC710N,PLEASE CALL:(952)249-4613
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPL[CANT WATER METER RESIDENTIAL 303.70
GULLICKSON, FRITZ WATER METER RESIDENTIAL HORN 86.64
3443 CRYSTAL PL
WAYZATA, MN 55391- TOTAL 390.34
OWNER _:ty uf Ot�c�,��:
-.'�u Ke1l�nl�et� ^a7Cr-[k:tiG:
GULLICKSON, FRITZ �:r�ano �'I�Y JJ.�.�O ����45-4;r,.
3443 CRYSTAL PL
WAYZATA, MN 55391- Receipt Na; 3.C�r�S49�, ��� _,� - _
�ritz Gullickso.
AGREEMENT AND SWORN STATEMENT
r""t'V1�1U5 BdIdYICc:
The work Yor which this permit is issued shall be performed according to ;�_, �
.�:e Qf Wtr Mett,
the approved plans and specifications,applicable City approvals,and the -�r.,, _
State Building Code. This petmi[is for only Ihe work described and does -"'�� ��"Ystal Plae� ?�,_,,_,
'_��i-s'3�14
not grant permission for additional or related work which requires sepazate �!a.,.,
permits. All provisions of laws and ordinances governing this type of work • ��11dYiBUUS RBVet:_c
__.__ _--. _ __
shall be compied with whether or not specified herein.This permit will '_a���
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]80 days at any time afrer work has commenced. '..4BCk ht]: 4ic8
The applicant is responsible for assuring all required inspections are �"3y�1':
requested in conformance with the State Building Code.This permit may be 'r`itY �U�I1Ck50ri
revoked at any time for due cause. �::�3: �ppiled: -- �
_..------.-.._ .__._
/ / / /
Applicant Permitee Signature Date Issued By Signature Date
SEPARATE PERMITS REQUTRED FOR WORK OTHER THAN DESCRIBED ABOVE.
FOR CITY USE ONLY
,� �� ',�` Citv of Orono
�� //� �O`Y\°' P.O.Box G6 Date Received: Permit#
'`'�� � `�I 2750 Kelley Parkway
��a )t`' �����_ ! Crystal Bay,MN 553'_3 Approved By:(If Required):
�';
d� ���, �,},u`� (952)249-4600
,�vr�o8�,/
CITY OF ORONO–VVATER METER FORM
(*Note:Some pennits may require approval by the Building Official ancl/or Public Works Department*)
GENERAL 1NFORMATION
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 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)
i
� Ne���Meter � Additional Meter—For. � Replacement Meter
Job Site/Owner Information:
/ � ,r
Site Address: �T��7 > CG� 4:� � 1���— -�?l —
Owner:���) �_ ��Lt'L�. � ��'����A�Iailing Address: %L � � � �1/�C, � L�;
�
�����
City: ������ I���' Zip: _��/ ��
,�� �� 1 � �.�� �� % �'7Z�
Home Phone: i� !L%"� C j��' Alternate Phone:
Contractor Information:
_ j
Contractor: ^�"f�� �� Contact Person: �,t jT'� ,
i-'_
� 7 , ,
Addres���y� � - � �f� >� State License #,:
' i�_.-
City: ��l`,'�� Zi�.f�.�Expiration Date:
' '_ �'� �� L" ��
Phone:��� �"� ��� �� ; Alternate Phone: ��� F.x-� �
�
� WATF.,R METER PERMIT FEES
:
W:ILL BE CAULULArCED BY CITY STAFF
❑ 5/8"METER- 3/4"METER- � 1"METER-
� 5/8"HORN - � 3/4"HORN - � l"HORN -
� "WATER METER (THESE WILL HAVE TO BE SPECIAL ORDERED&PRICES DETERMINED)
1. METER FEE: $
"�>�7J• 7��
2. HORN FEE $ l-=' ' `� �
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) $ `� ��� " � I � �
CITY-USE ONLY �
* For Current Pricing Refer to Current Year- Water Meter Pricing Chart *
BRAND: 1�1� {/�_Ll `�'�
I �4
sizE: ❑ sis�° [�] 3i4�� ❑ �°° ❑other �� 52191608
SERIAL#: IIII I I II III IiIII IIII IIIII IIIII IIII IIII
ERT HIGH#: �� �������� 7 � �' (if applicable)
C��� �i I ( c>( :����� �i ��cfi
ADDITIONAL 1NFORMATION—WATER METERS
The undersigned hereby applies to the City of Oron9 for issuance of a water meter permit, agrees
to do all work in strict a ordance wit the �r}ances of the City and the regulations of the State
of Minnesota, and c �fies tl�at all te ade on this application are,true and correct.
��
" ,� /' I �� �
Applicant: Date: ��� �� �1 ��
� �--�
Reset Form
O�-iginal: 1-Address File
Make Copies For: 1- Utility BilZing Department 1-Cash Drawe�-