HomeMy WebLinkAbout2016-00946 (water meter) � �
CITY OF ORONO * Z 0 1 6 - 0 0 9 4 6 *
2750 KELLEY PARKWAY DATE ISSUED: 08/10/2016
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 525 KEENE AVE
PIN : 02-117-23-31-0027
LEGAL DESC : MINNETONKA BLUFFS
: LOT 000 BLOCK 015
PERMIT TYPE : WATER METER-RESIDENTIAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER METER-RESIDENTIAL
NOTE: INSEPCTIONS ARE DONE BY PUBLIC WORKS DEPARTMENT.
TO SET-UP AN INSPECTION,PLEASE CALL:(952)249-4613
3/4"NEPTLTNE METER
SER[AL NUMBER 53466878
ERT HIGH# 154007800
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 294.42
WATER METER RESIDENTIAL HORN 97.57
LARSON PLUMBING INC. TOTAL 391.99
3095 162ND LANE NW Payment(s)
ANDOVER,MN 55304 CHECK 30902 391.99
(763)427-7680
Minnesota State License#:plbg-0841699
OWNER
H&J Development Prtnrshp
DETTLOFF, HB&JC
1001 TWELVE OAKS CENTER DR#10
WAYZATA, MN 55391-
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 governing 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 180 days at any time afrer work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with t State Building Code.This permit may be
revoked at any time r c e.
� � �- �l $ �, � �/�
App � nt Permitee Signature � t Issoed By ' nature Date
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C Y DSE ON�.Y
City of Orono � )� C� (�
�-�� P.O.Box 66 Datc R�aeiv .�����Peticait#OC.(J��' / /�
� 2750 Kefley Pazkway
Crystal Bay,MN 55323 Approved By:(IfRequired);
(952)249-4600
�F�-�,�E o��.�'� CITY OF ORONO-WATER METER FORM
SH (]Vote:Some permits may require approval by the Building Official and/or Public Works Department) I
GENERAL INFORI�IATION
1. 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)249-46]6. 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 Infarmation:
Site Address: ��� ��,t� �vr-
Owner: �.��tri�'/d�l� Mailing Address: ��J� ,�/c.�/,}�//
r
City: ��fJ� /� r n� Zip:
Home Phone: �i��,��G/��-7��5'd Alternate Phone:
Contractor Informa#ion:
Contractor: �c�,r��h � �at �J i!?� Contact Person: c � �"
/�� "�iq )�6 r�
Address: ;�`� ve' State License #: y�� C%�
i
City: C� Zip���{ Expiration Date: � � � 7
Phone: ����'''���`-7�� Alternate Phone: ��'y�vZ�'���� i
'� 1
:��ATEIZ METER PERMIT FEES
V4'Ii,L BE CAULULATED BY CITY STAFF
❑ 5/8"METER- /4"METER- � 1"HORN -
❑ 5/8"HORN - 3/4"HORN - ❑
� "WATER METER SE WILL HAVE TO BE SPECIAL 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 *
3/4
s�,ND: 53466878
SIZE: ❑ 5/8" �-3/4" ❑ 1" ❑Other '� IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�III
SEWAL#:
ERT HIGH#: 15�40407800 (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 Minnesota, and certifies th 1 tements made on this application are,true and correct.
-:�
Applicant: ''�J' Date: � �a ��
Original: 1-Address File
Make Copies For: 1- Utiliry Billing Department