HomeMy WebLinkAbout2015-00358 - water meter + � . -� CITY OF ORONO * 2 0 1 5 - 0 0 3 5 B *
2750 KELLEY PARKWAY DATE ISSUED: 03/31/2015
ORONO,MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 3443 LIVINGSTON AVE
PIN : 17-117-23-43-0064
LEGAL DESC : NAVARRE HEIGHTS
: LOT 006 BLOCK 005
PERMTT 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
5/8"METER
ERT HIGH# 1834490973
SERIAL#93297926
WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 242.65
TOTAL 242.65
HEGER,DENNIS Payment(s)
3443 LIVINGSTON AVE CHECK 242.65
WAYZATA,MN 55391
OWNER
HEGER,DENNIS
3443 LIVINGSTON AVE
WAYZATA,MN 55391
AGREEME1vT AND SWORN STATEMENT
The work for which this pertnit is issued shall be performed according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. 'I'his permit is for only the work described and does
not grant permission for additional or related work which requires sepazate
permits. All provisions of laws and ordinances goveming 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 after work has commenced.
The applicant is responsible for assuring all required inspections aze
requested in conformance with the State Building Code.This pertnit may be
revoked at any time for due cause.
�'Lp1 rl.� g L' � a2 $1 � � ��/ �
Applicant Permitee Signature Da e Issued By gnature Date
r : . •�
FOIt C1TY USE t31�1LY
�O�O City of Orono '
P.O.Box 66 T�ate RecCived: Pertnh#
2750 Kelley Parkway
Crystal Bay,MN 55323 Approved F3y:(IfR�quired):
(952)249-4600
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�AkESki���G CITY OF ORONO—WATER METER FORM
(Note:Some permiks may require approval by the Building Official and/or Public Works Department)
GENERAL INFORMATIaN °
1. WATER METERS must be picked up and paid for at City Hall.
2. If nossible,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 O�'PERIVIIT
Ch�cic�Il�That A 1
❑Residential(May Require Approval) ❑Commercial(Approval Required)
❑ New Meter ❑Additional Meter—For: ❑ Replacement Meter
Job Site i C)v�ner Information: ``
Site Address: � � �`� 3 (�i v�1 R�G 2 `�'� n �"lJ'e-- '
Owner: � � (-�� <- Mailing Address: 3 � �' 3 �v t r��ST 0 n �k tr�
City: �, �'��a4'f'� Zip: s J`�' �`T I
Home Phone: � � � ' C� 3 � � Alternate Phone:
Contra.ctc�r Information: '
Contractor: Contact Person:
Address: State License#:
City: Zip: Expiration Date:
Phone: Alternate Phone:
� . , �
x�
� �;�
/8"METER- ❑ 3/4"METER- ❑ 1"METER-
❑ 5/8"HORN - ❑ 3/4"HORN - ❑ 1"HORN -
❑ "WATER METER (THESE 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 *
BRAND:
SIZE: " ❑ 3/4" ❑ 1" ❑ Other "
SERIAL#: � J � �! L—�o
ERT HIGH#: III III IIII II II II III II II I IIII (if applicable)
1834490973
ADDITIONAL INF4RMATION'—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.
Applican • rti.•� � . .e Date: 3�
Original: 1-Address File
Make Copies For: 1- Utility Billing Department