HomeMy WebLinkAbout2015-00359 - water meter CITY OF ORONO * 2 0 1 5 - 0 0 3 5 9 *
. . . -� 2750 KELLEY PARKWAY DATE ISSUED: 03/31/2015
ORONO, MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS : 3825 NORTH SHORE DR
p� : 17-117-23-22-0046
LEGAL DESC : SHERRI LAKEVIEW ESTATES
: LOT 004 BLOCK 001
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"WATER METER
ERT HIGH# 1852385619
SERIAL#67229345
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 242.65
WATER METER RESIDENTIAL HORN 80.42
NORTH ANOKA PLUMBING TOTAL 323.07
22590 RUM RIVER BLVD.N.W. Payment(s)
MN 55070- CREDIT CARD 0367 323.07
(763)753-3373
OWNER
LANDSOUCE
3845 NORTH SHORE DR
MOUND,MN 55364
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 dces
not grant permission for additional or related work which Sequires separate
permits. All provisions of Iaws and ordinances goveming this type of work
shall be compied with whether or not specified herein.This perrrtit 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.
1'he applicant is responsible for assuring all required inspections aze
requested in conformance with the State Building Code.This permit may be
revoked at any time for due cause.
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App icant Permrtee Signature Date ssue y Signature Date
FOR CITY LtSE ONLY
�O�O City of Orono
P.O.Box 66 Date Received: Permit#
2750 Kelley Parkway
Crystal Bay,MN 55323 Approved By:(If Required):
(952)249-4600
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CITY OF ORONO—WATER METER FORM
��K�SH��� (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 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 Ap ly) �
�Residential(May Require Approval) ❑ Commercial(Approval Required)
�New Meter ❑ Additional Meter—For: ❑ Replacement Meter
Job Site/Owner Information:
Site Address: 3� a S ttiae's�► sHcR rc ��L •
Owner: �L� S ���E_ 5 Mailing Address:
City: Zip:
Home Phone: Alternate Phone:
Contractor Information:
� ,{ � �
Contractor: �'UOQT� tt�oK� J[.v^+g�NG Contact Person: �q�CC�✓ ��1^�SE•�-�
Address: �?aS f0 �u,M �i�:P ,��v� State License #: �C G �2 ��/
/
City: .Sr� ��Qq✓c�S Zip:$�So7� Expiration Date: �✓��� � �� � �
Phone: 7�3 �S3 " �3�j Alternate Phone: 1� �a a�q a o? S�
WATER METER PERM�T FEES �
� '� WILL BE CAULULATED BY CITY STAFF �
5/8" METER- ❑ 3/4" METER- ❑ 1"METER-
/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) $ � �?J � � /
CITY-USE ONLY
* For Current Pricing Refer to Current Year - Water Meter Pricing Chart *
BRAND: � ��—
SIZE: �8" ❑ 3/4" ❑ 1" ❑ Other "
SERIAL#: l�—Z �d=��J `�S
ERT HIGH#: III III III III I III III I IIII II III (if applicable)
1852385619
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.
�.,...
Applicant: /�� ��7 /` �"'�'- Date: .3 3/ ��
Original: 1-Address File
Make Copies For: 1- Utility Billirrg Department