HomeMy WebLinkAbout2014-01477 - water meter `' � CITY OF ORONO * 2 0 1 4 - 0 1 4 7 7 *
2750 KELLEY PARKWAY DATE ISSUED: 12/30/2014
ORONO, MN 55356-
(952) 249-4600 FAX: (952 249-4616
ADDRESS : 3655 NORTH SHORE DR
PIN : 08-117-23-34-0050
LEGAL DESC : CRYSTAL BEACH
: 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
5/8"METER
SERIAL#94069729
ERT HIGH# 1850420984
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 245.70
WATER METER RESIDENTIAL HORN 68.97
PREFERRED PLUMBING INC MISC FEE 0.00
6400 HIGH POINT TRAIL
PRIOR LAKE,MN 55372- TOTAL 314.67
(952)447-5761 Payment(s)
CHECK 3528 314.67
OWNER
HAGEN,AL& DONNA
3655 NORTH SHORE DR
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
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
revo t any time due cause.
-3�`J / / l��l �
App icant Pe �ee ignatu e Date Issue By Signature Date
� ,
_Fq �USE ONLY '
�O A T City of Orono �f�/
i V P.O.Box 66 Date Received:� � Permit#
� 2750 Kelley Parkway
Crystal Bay,MN 55323 Approved By:(If Re ired):
(952)249-4600
y� �
�qkFSH�RF.G CITY OF ORONO—WATER METER FORM
(*Note:Some permits may require approval by the Building Official and/or Public Works Departrnent
•�
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 I )
�-Residential(May Require Approval) ❑ Commercial(Approval Required)
❑ New Meter ❑Additional Meter—For: ❑Replacement Meter
Job Site/Owner Information:
Site Address:
36 � 5 /1��r�� �h�� � �
Owner: Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
Contractor: ���°MC� �1��i✓��ontact Person: �p r y f►ilGl/L�/✓
Address: �5�a ��r�� 1-���1'�C � State License#:
City: C ��f �Zip:/�� Expiration Date:
Phone: �l� ��3 q��,(C( AlternatePhone:
�,�s��,� � _� i�A'1`��� ��P . > �r�� � ����� , ,�� �� � ,�
1��,ri " h . ,- � 1 fi `isy � b Y
; �Vi�L��:�C�.C7�;�A��� '� � t�
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—i i�
n �
y, C �
/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" ❑ 3/4" ❑ 1" ❑ Other "
SERIAL#: ��Q�p '�f ?oZ�
ERT HIGH#: III III IIII I III III II II IIII II II (if applicable)
1850420984
ADDITIONAL INFORMATION—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 d certifies that all statements made on this application are, true and correct.
Applica : Date:l� ��G��
Original: 1-Address File
Make Copies For: 1- Utility Billing Department 1-Cash Drawer