HomeMy WebLinkAbout2014-01450 - water meter . CITY OF ORONO *Z 0 1 4 - 0 1 4 5 0 *
� - 2750 KELLEY PARKWAY DATE ISSUED: 12/19/2014
ORONO, MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 3320 NAVARRE LA
PIN : 17-117-23-44-0059
LEGAL DF.SC : WILEYS NAVARRE ADDN LAKE MTKA
: LOT 001 BLOCK 000
PERMIT TYPE : WATER METER- RESIDENTIAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WATER METER- RESIDENTIAL
NO"l�E: INSEPCTIONS ARE DONE f3Y PUBLIC WORKS DEPARTMENT.
1'O SET-UY AN INSPGCTION, PLEASE CALL:(952)249-4613
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 245.70
WATER METER RESIDENTIAL HORN 68.97
SERVEY PLUMBING
10609 166TH ST W TOTAL 314.67
LAKEVILLE, MN 55044- Payment(s)
(952)393-1272 CHECK 5939 314.67
OWNF.R
CUBE INC.
4825 HANOVER ROAD
MOUND, MN 55364-
AGREEMEIYT AND SWORN STATEMENT
The work for which this permit is issued shall be performed accordine to
the approved plans and specifications,applicable City approvals,and the
State I3uilding 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."rhis pemiit will
expire and become null and void if eonstruction authorized is not
commeneed within 180 days of the date of issuance,or if construction is
suspended Yor a period of 180 days at any time after work has commenced.
The appficant is responsible for assuring all required inspections are
requested in conformanee with the State Building Code.�I�his permit may be
revoked at any time for due cause. ���
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Applicant Permitee Signature � Date Issued By Signature Date
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FOR CITY USE�1VLY
�O . ` City of Orono
1VO P.O.Box 66 Date Recei�ed: Permit#
2750 Kelley Parkway
Crystal Bay,MN 55323 Approved By:(IfRequired):
(952)249-4600
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�qk�SHp�F.�' CITY OF ORONO—WATER METER FORM
(*Note:Some permiu may require approval by the Building Official and/or Public Works Department
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GENERAL 1NFORMATION
1. WATER METERS must be picked up and paid for at City Hall.
2. If nossible,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 PERIVIIT
(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: �/ �� /���'�r� �'�
-�
Owner: �2 0'�� �4 G� �-S�. Mailing Address:
City: �1 oU �� � Zip; .�'�S 7j 6 �
Home Phone: � G S � , 2 7� ��� ��Alternate Phone:
Contractor Information:
Contractor: �e r�ev �/'a�,�Ov Contact Person: �� ��� ��/�v�
Address: �6��� � � State License#: ��-� � �2� �S �l
City: ����tI�e M�Zip:�5 3��Expiration Date: �2����2-� ���
Phone: ��5 2- 3`r 3 ��272 Alternate Phone: �`�S 1 1 ��y— � �6 v
.
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WATER METER PERMIT FEES
WILL BE CAULULATED BY CITY STAFF
�5/8"METER- ❑ 3/4"METER- ❑ 1"METER-
�'S/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" ❑ 3/4" ❑ 1" ❑ Other "
sE�uAL#: ��o( 9 �d�
IIIIIIIIIIIIII IIIIIII IIIIIIII (if applicable)
ERT HIGH#: 1850421014
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: 1- Utility Billing Department 1-Cash Drawer