HomeMy WebLinkAbout2010-00528 - water meter r � CITY OF ORONO PERMIT NO.: 2010-00528
2750 KELLEY PARKWAY
. ORONO, MN 55356- DATE IssuEn: 06/28/2010
"' 952 249-4600 FAX: 952 249-4616
ADDRESS : 25 MYRTLEWOOD RD
PIN : 36-118-23-33-0014
LEGAL DESC : MYRTLEWOOD
: LOT 002 BLOCK 002
PERMIT TYPE : WATER METER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER METER
NOTE: INSEPCTIONS ARE DONE BY PUBLIC WORKS DEPARTMENT.
TO SET-UP AN INSPECTION,PLEASE CALL:(952)249-4613
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 268.05
RYAN, STEVEN&ANNE WATER METER RESIDENTIAL HORN 66.83
25 MYRTLEWOOD RD
WAYZATA, MN 55391- MISC FEE 0.00
TOTAL 334.88
OWNER
RYAN, STEVEN&ANNE
25 MYRTLEWOOD RD
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 an ecome null and void if construction authorized is not
comme ced hin 180 days of the date of issuance,or if construction is
suspe ded or a eriod of 180 days at any time after work has wmmenced.
The ppli ant is esponsible for assuring all required inspections are
r e e in co ormance with th�.Stale-�Btrilding Code.This permit may be
rev ked t any ime for �se.
- /7(Y / � �/
A�p i t rmitee Signature Date � �
� Issued By S' ature ate
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED A OVE
.- �s
� FOR CITY USE ONLY
' ,���, City of Orono
O , O P.O.Box 66 Date Received: Permit#
�,s, 2750 Keliey Parkway
a
y �7�'�1,;<�. F Crystal Bay,MN 55323 Approved By:(If Required):
��,����o` (952)249-4600
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 mus�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 Apply)
�Residential(May Require Approval) ❑ Commercial(Approval Required)
�New Meter ❑Additional Meter—For: ❑ Replacement Meter
Job Site / Owner Information:
Site Address: o�� M(.�I^�'�L�l,c.�OD d �
Owner: �r-� G �` Mailing Address: �� I"�� c�-�—��-�:� !'�
c�ty: (��� ,�� z�p: `�� .SS"3 � I
Home Phone: (�S Z ��-(7 � �I S ��-- Alternate Phone: �, �� 2 � �C�3 '� `( � �
Contractor Information:
� l ( � l c�/?� � '� ��r' � �,.��.`�t_!.�
Contractor: � 5 , � Contact Person:
Address: State License #:
City: Zip: Expiration Date:
Phone: �Gt � � � � S�� � S��� Alternate Phone: 1 Z �c�� - ��j ��`-�
� �J
WATER METER PERMIT FEES �
� WILL BE CAULULATED BY CITY STAFF
�[� /8"METER- ❑ 3/4"METER- ❑ 1"METER-
/8"HORN - ❑ 3/4"HORN - ❑ 1"HORN -
❑ "WATER METER (THESE WILL HAVE TO BE SPECIAL ORDERED&PRICES llETERMINED)
1. METER FEE: $ ��O �• ��
2. HORN FEE $ l0 � ' ��
3. TOTAL PERMIT FEE (Add Lines 1-2 Above) $ ��� . [��
CITY-USE ONLY
* For Current Pricing Refer to Current Year- Water Meter Pricing Chart *
B�.ND: Neto
SIZE: �5/8" ❑ 3/4" ❑ 1" ❑ Other "
SERIAL#: �� _r v�5� I
ERT HIGH#: IIIIII IIIIIIII III I II III IIIIII
1830727525 (if applicable)
ADDITIONAL INFORMATION—WATER METERS
The undersigned hereby plies to the City of Orono for issuance of a water meter permit, agrees
to do all work in strict c orda with the ordinances of the City and the regulations of the State
of Minnesota, a cer if es t t 1 statements made on this application are, true and correct.
Applicant: Date: � / .�
Original: 1-Address File
Make Copies For: I- Utility Billing Department 1- Cash Drawer