HomeMy WebLinkAbout2016-00426 - water meter ,+ s . CITY OF ORONO * 2 0 1 6 — 0 0 4 2 6 * ,
2750 KELLEY PARKWAY DATE ISSUED: 04/26/2016
ORONO,MN 55356- .
(952)249-4600 FAX: (952)249-4616
ADDRESS : 10 MYRTLEWOOD RD
pIN : 36-118-23-33-0009
LEGAL DESC : MYRTLEWOOD
: LOT 001 BLOCK 001
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
1"NEPTUNE METER
ERT HIGH#1541667976
SERIAL#53591582
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 372.06
WATER METER RESIDENTIAL HORN 144.64
CHAMBERLAIN FINE CUSTOM HOMES TOTAL 516.70
11578 CHAMBERLAIN CT Payment(s)
EDEN PRAIRIE,MN 55344 CHECK 3366 516.70
(952)649-7653
Minnesota State License#:BUIL-BC661410
OWNER
Chamberlain Capital LLC
11578 CHAMBERLAIN CT
EDEN PRAIRIE,MN 55344-
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 dces
not grant permission for additional or related work which requires separate
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 suthorized 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 are
requested in conformance with the State Building Code.1'his permit may be
revoked at any time for due cause. �
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Applicant Permitee Signature Date ssued B gnature Date
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FOI� ITY IISE ONLI'
,�O A T City of Orono �/, � �' `�
1 y P.O.Box 66 Date Rec i���� Permit � �r�
� 2750 Kelley Pazkway
Crystal Bay,MN 55323 ApprovEdBy:(IfRtquired):
(952)249-4600
y���skE o���'Z CITY OF ORONO—WATER METER FORM
SH (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 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 A 1
�.Residential(May Require Approval) ❑Commercial(Approval Required)
t�
� �New Meter ❑Additional Meter—For:
❑Replacement Meter
Job Site/Ou�ner Information:
Site Address: �' !�%�' � '�� ; . < <, `� i;J cl
-� n ;
Owner: nan�r>>��:�u�� ��p;�,` �� � MailingAddress: /�.��� �hamh-�����h ��
c�ri� � �^ ��, �,:� ��1„� z�p: SS3�/�
Home Phone: Alternate Phone: �5�`�o �/ ` �� 5 3
Contractor Informatian:
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Contractor: ; ,�,:,�� l:_ %u,r� /=�,r� i ���_r��i rr � , �,� � �� (r��_-� J G��
Contact Person:
Address: State License #:
City: Zip: Expiration Date:
Phone: �5 a� A�ternate Phone:
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WATER METER PERMIT �EES
WILL BE CAULULATED 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: $
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: ED2F11 RDG3 �
i,.
SIZE: ❑ 5/8" ❑3/4" ❑ 1" ❑Other " 53591582
�illlll IIIII IIIII IIIII IIIII IIIII IIIiI Ilill IIII IIII
SERIAL#: --
ERT HIGH#: °1°�����������������ii����� (if applicable)
1541667976
ADDITIONAL INFOiZ.MATION—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.
Applicant:
� f-� Date: �/ °Z� �L�
Original: 1-Address File
Make Copies For: 1- Utiliry Billing Department