HomeMy WebLinkAbout2012-0014 - water meter r t •
" �- . CITY OF ORONO * z 0 1 Z — 0 0 1 4 5 *
2750 KELLEY PARKWAY DATE ISSUED: 02/22/2012
ORONO, MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 30 MYRTLEWOOD RD
PIN : 36-118-23-33-0011
LEGAL DESC : MYRTLEWOOD
: LOT 003 BLOCK 001
PERMIT TYPE : WATER METER
PROPERTY TYPE : RESIDENT[AL
CONSTRUCTION TYPE : WATER METER
NO"I'F: INSEPCTIONS ARE DONG [3Y PUBLIC WORKS DEPARTMENT.
TO SGT-UP AN INSPECTION,PLEASE CALL:(952)249-4613
NEP"fUNE 1" W'ATF;R METGR-SGRIAL#51390822-ERT# 1820457158
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 392.92
MUSKA PLUMBING WATER METER RESIDENTIAL HORN 104.45
1985 OAKCREST AVE TOTAL 497.37
ROSEVILLE, MN 55113-
(651)286-0056 PAID WITH CC# 0541
Minnesota State License#: 60919-PM
OWNER
PAULSON, BRUCE& LORI
30 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 lor only the work described and does
not grant permission for additional or related work which requires separate
pennits. 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 after work has commenced.
The applicant is responsible for assuring all required inspections are
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
(,_��� � / '��• � ola 12 �_ � � � ��
Applicant mrtee Signature Date Iss By Signature Datc
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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FOR CITY USE ONLY
r- p�x��,, City of Orono � l.�J!'
���� `���� P.O.Box 66 Date Received: Permit��
I �, }I 2750 Kelley Parkway
`�� ,1)i�` rv- N/;f Crystal Bay,MN 55323 Approved By:(IFRequired):
�a + i ,}.c`� (952)249-4600
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CITY OF ORONO-WATER METER FORM
(*Note:Some permits may require approval by the Building Official and/or Public Works Department*)
GENERAL INFORMATION
1. VVATER METERS must be picked up and paid for at City Hall.
2. If possible,fax in this application ahead of time;we wil]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)
�New Meter � Additional Meter—For: � Replacement Meter
Job Site/Owner Information:
Site Address: � �yR'��'e. L�Ot�CI ��, •
Owner: �D R� ��W��.�A Mailing Address: 5,�4►we
City: W'a1/�.�'� Zip: �"�7��I�1
Home Phone: �`�J�—y�3"0�.� Alternate Phone:
Contractor Information:
Contractor: �t�sl�a�'I�b9� Contact Person: ��1�Ay ���
Address: �ag5 OC1rCC(�L��'�IAde.. State License #: ��� � � - � �
City: �3ev i(��, Zip:� Expiration Date: j 2 - 3 ) � �ol�
Phone: ,�S�' %1$b `�bb Alternate Phone: (0,5�' 231- 125',_,5
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WATF,R ME"I'ER 1?ER1V[IT FEES
WILL B� CAULUL.ATED BY CITY S'I'AFF
❑ 5/8"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: $ � / a�� 41
2. HORN FEE $ ! U " �,S
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: ❑ 5/8" ❑ 3/4" ❑ 1" ❑ Other "
SERIAL#: �/ ?j 9� �a2��
ERT HIGH#: ����������������������������� (if applicab]e)
1820457158
ADDITIONAL 1NFORMATION—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: � Date: �` a�" �+� (2
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Original: 1-Address File
Make Copies For: 1- Utiliry Billing Department 1-Cash Drawer