HomeMy WebLinkAbout2014-00925 - water meter � •. •
CITY OF ORONO * 2 0 1 4 - 0 0 9 2 5 *
2750 KELLEY PARKWAY DATE ISSUED: 08/20/2014
ORONO, MN 55356-
(952) 249-4600 FAX: 952) 249-4616
ADDRESS : 60 MYRTLEWOOD RD
PIN : 36-118-23-33-0020
LEGAL DESC : REG. LAND SURVEY NO.0446
: LOT 000 BLOCK 000
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
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL HORN 68.97
VETSCH PLUMBING WATER METER RESIDENTIAL 303.70
116 CENTRAL AVE E TOTAL 372.67
ST MICHAEL, MN 55376- 1'ayment(s)
(763)497-9733 CHECK 18821 372.67
OWNER
HARTMAN,TODD
60 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 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
ommenced within 180 days of the date of issuance,or if construction is
s pended for a period of 180 days at any time after work has commenced.
Th applicant is responsible for assuring all required inspections are
eq ested conformance with the State Building Code This permit may be
evo ed a y or ue ca e.
� ° / /
Ap lacant Pe �te ignature ate Issued By ' ature Date
� . ~ �r �V���
FOR CITY USE'ONLY '
City of Orono
�-O�O P.O.Box 66 Date Received: Permit#
2750 Kelley Parkway
Crystal Bay,MN 55323 Approved By:(If Required):
(952)249-4600
y� �'
�qx�SH��F.�' CITY OF ORONO-WATER METER FORM
(*Note:Some permiu may require approval by the Building Official andlor 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)
�New Meter ❑Additional Meter—For: ❑Replacement Meter
7ob Site/Owner Information: `
Site Address: Y V� 0
wner: `� Mailin Address: ll1� ��''�
O � g
��ty: -�. Z�p: SS 3�i 1
Home Phone:
6 a '�/�o ���� Alternate Phone:
Contractor Information:
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Contractor: U�'1�� Contact Person: �
]Q��J� �
Address: f ( � � � 1 ��-'"State License#: �� ���
� �53'�� 3�
City: �� �C���p: xpiration Date: I� ��
Phone: �l9�7 ' "�l�'��33 Alternate Phone:
Y a� t
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Y
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�k` n .,° �*h p.: � �. �
� ` � v ' 1 ..'. �. ��
❑ 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 *
BRAND: �
SIZE: ❑ 5/8" �/4" ❑ 1" ❑ Other "
SERIAL#: � a � � � " ��
ERT HIGH#: IIIIIIIIIIIIIIIIIIIIIIIIBIII (if applicable)
1831447917
'ADDITIONAL INFORMATION—WATER METERS <
The undersign d ereby applies to the City of Orono for issuance of a water meter permit, agrees
to do all work 'n trict ord ce with the ordinances of the City and the regulations of the State
of Minneso , certi i s t at 1 tat ments ma on this application are,true and correct.
Applicant: Date:
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Original: 1-Address File
Make Copies For: 1- Utility Billing Department 1-Cash Drawer