HomeMy WebLinkAbout2015-00448 - water meter � ` CITY OF ORONO
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2750 KELLEY PARKWAY DATE ISSUED: 04/17/2015
ORONO, MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 3220 NAVARRE LA
PIN : 17-117-23-44-0058
LEGAL DESC : WALLACES ADDN TO VIL OF MTKA B
: LOT 064 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
3/4" METER-SERIAL#53314728 -ERT HIGH- 1852890628
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 294.42
WATER METER RESIDENTIAL HORN 80.42
HARRINGTON, DARIN MISC FEE 0.00
3220 NAVARRE LANE
WAYZATA, MN 55391- TOTAL 374.84
Payment(s)
CREDIT CARD 5139 374.84
OWNER
HARRINGTON, DAR1N
3220 NAVARRE LANE
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 sepazate
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
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 cesponsible for assuring all reqoired inspec[ions are
cequested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
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Ap n e e Sig ture Date Issued y Signature Date
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�OR CI Y L�ONLY � ' �
City of Orono �� �.� ��� �
��� P.O. Box 66 Date Recei�e :l� PermiC#
0 2750 Kelley Parkway 1�
Crystal Bay,MN 55323 Approved By(If Required): � �� �J
(952)249-4600 � ���
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CITY OF ORONO-WATER METER FORM
`�kFs H��� (Note:Some permits may require approval by the Building Ofticial and/or Public Works Department)
GENERAL INFORMATION
l. 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 PF,RMIT
� (Check All That Apply)
❑ Residential (May Require Approval) ❑ Commercial(Approval Required)
❑ New Meter ❑ Additional Meter—For: ❑ Replacement Meter
Job Site/ Owner Information:
Site Address:
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Owner:��'"� ��"`"�'�'��'' -' MailingAddress: -���'� ���"� ����
City: L��� ,,�,,� Zip: ��f 3�
Home Phone: Alternate Phone: �Q t2- S����/
Contractor Information:
Contractor: Contact Person:
Address: State License#:
City: Zip: Expiration Date:
Phone: Alternate Phone:
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WATER METER PEI�MIT FEES
� � ��WILL BE CAULULATED BY CIT�' STAFF � .
❑ 5/8"METER- �3/4"METER- ❑ 1" METER-
❑ 5/8"HORN - 3/4"HORN - ❑ 1" HORN -
❑ " WATER METER (�'HESE 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" ❑ 3/4" ❑ 1" ❑ Other "
SERIAL#: � .� � l Y- 7 � D
ERT HIGH#: III III III III II II III I III III III (if applicable)
1852890628
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.
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Applicant: � Date:
Original: 1-Address File
Make Copies For: I- Utility Billing Department