HomeMy WebLinkAbout2010-00113 - water meter ` CITY OF ORONO PERMIT NO.: 2010-00113
2750 KELLEY PARKWAY
r - ORONO, MN 55356- DATE ISSUEn: 02/26/2010
952 249-4600 FAX: 952 249-4616
ADDRESS : 50 MYRTLEWOOD RD
PIN : 36-118-23-33-0006
LECAL DESC : REG. LAND SURVEY NO. 0446
: LOT 000 BLOCK 000
PERMIT TYPE : WATER METER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER METER
NOTE: INSEPCTIONS ARE DONE BY PU[3LIC WORKS DEPAR"[�MENT.
TO SET-UN AN INSPF,CTION,PLEASE CALL: (952)249-4613
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 394.67
EARL W. DAY& SONS, INC. WATER METER RES[DENTIAL HORN 104.45
P.O. BOX 294
LONG LAKE, MN 55356 MISC FEE 0.00
�� TOTAL 499.12
OWNER
CHAMPLIN, MR. &MRS.
50 MYRTLEWOOD RD
WAYZATA, MN 55391-
AGREEMENT AND SWORN STATEMENT
7'he work for which this permit is issued shall be performcd according to
the approved plans and specitications,applicable City approvals,and thc
State Building Code. "l�his permit is for only the work described and docs
not grant pennission for additional or related work which requires separate
pennits. All provisions of laws and ordinances goveminb 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 l80 days of the date of issuance,or if construction is
suspended for a period of I 80 days at any time after work has commenced.
The applicant is responsible for assuring all required inspections are
re ested in c mance the State Building Code.'rhis permit may bc
r v ec�.�an ti for e use.
� �l a(� � !c� p ��YK..GL��, � �
Applicant P mitee Signature Date Issued By Si ature Dat
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED OV
�-
' � FOR CITY L'SE ONLY
,���, City of Orono
P.O.Box 66 Date Received: Permit#
��;;�{»� � 2750 Kelley Parkway
�� ��.�`,-'. F Crystal Bay,MN 55323 Approved By:(If Required):
����,�A��o` (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. WATER METERS must be picked up and paid for at City Hall.
2. If osp sible,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: �C�� �'�� ,�� ���,�G�c{� �
Owner: C�v1r� 1� y� Mailing Address:
City: ��'��� Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor: �cc✓'� 1,�,1� ���✓JS Contact Person: �r Q 1�1������'�V�Sv 1�J
Address: �n ��f� J.�l� �j/'rh1�i�State License#: 2.. �� d�j���
City: �C. Zip:� Expiration Date:
Phone: ��, �7 � ���� Alternate Phone: �n l��-�C�(o���
+
WATER METER PERMIT FEES
WIL,L BE CAULULATED BY CITY STAF:F
❑ 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: $
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 *
B RaND: ,��t�.�-�-r.�c a�. �
SIZE: ❑ 5/8" ❑ 3/4" �1" ❑ Other "
�_ . 1.. ,-_ .. r,
SERIAL#: �' � .� ? ''� `�f '? �'(
ERT HIGH#: III III IIII I IIII II I I IIIII I IIII
— 1820841336 (if applicable)
ADDITIONAL INFORMATION—WATER METERS
The undersigned hereby applies to the City of Orono for issuance of a water meter permit, a�-ees
to do all work in strict accordance with the ordinances of the City and the regulations of the State
of Minnesota, certifies t all statements made on this application are, true and correct.
;
Applicant: �-- Date: � s ��
�� �–
Original: 1-Address File
Make Copies For: 1- Utiliry Billing Department 1- Cash Drawer