HomeMy WebLinkAbout2018-00184 - water meter CITY OF ORONO I111111 I 1I I I I I I I III IIII *
2750 KELLEY PARKWAY DATE ISSUED: 02/22/2018
ORONO,MN 55356-
(952) 249-4600 FAX: (952) 249-4616
ADDRESS : 1755 CONCORDIA ST
PIN : 17-117-23-22-0018
LEGAL DESC : COFFEES ADDN TO SHADY WOOD LAK
: LOT 012 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"NEPTUNE METER
SERIAL 36789312
ERT# 1548109284
WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 253.00
TOTAL 253.00
DANA HOAGLAND PLUMBING INC Payment(s)
410 REGENCY LANE W CREDIT CARD 1341 253.00
HOPKINS,MN 55343-
(952)935-5150
OWNER
KOHRS,DOUGLAS
1755 CONCORDIA ST
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 governing 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
revoked at any time for due cause.
Applicant Permitee Sign. ire Date Issue. By Signature Date
Ili CITY Ute WEN
City of Orono
WPO.Box 66Received. f Wit#vu��'Q���ii
2750 Kelley Parkway ,kCrystal Bay,MN 55323 Approved�y:(WR r :1
(952)249-4600o4 � CITY OF ORONO-WATER METER FORM
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 meter installation.
TYPE OF PERMIT
(Check All That Apply)
Residential(May Require Approval) 0 Commercial(Approval Required)
0 New Meter 0 Additional Meter—For: Replacement Meter
Job Site/Owner Information:
Site Address: 1755 Co nc-0 acSL cam. 2 (--
Owner: Dc', CA11_0(y 665 Mailing Address:
City: Cw --(-)/ L.,-)1 z—tom Zip: 5S 39 I 93/c;
Home Phone: Alternate Phone:
Contractor Information:
Contractor: OcC I` C t Npo Ulu' ontact Person: dACo J g c►e Le.K
Address: 41 U Visi,en
State License#: tplo7 5c - P m
City: t (I[Wlit5S Zip: 653+ Expiration Date: 12115
Phone: 62(A- °;---i37 Alternate Phone: d15P-935-5150
I .' �'t M V LrAT 1� T'3 . . 50....i- ':=‘=e-,-1:;. -%*,
5/8"METER= ❑
❑ 5/8"HORN 0 HORN3/4" - ❑ 1"HORN -
❑ "WATER METER (THESE WILL HAVE TO BE SPECIAL ORDERED&PRICES DETERMINED)
1. METER FEE: $ i;5--3,1 -0
2. HORN FEE $
3. TOTAL PERMIT FEE(Add Lines 1-2 Above) $ ' a 0
I CITY-USE ONLY
* For Current Pricing Refer to Current Year- Water Meter Pricing Chart *
ED? RD ►f-A
511 x G3
BRAND:
Ak-pfg---KL-e_ B11 G3
36789312
SIZE: ❑ 5/8" ❑ 3/4" ❑ 1" ❑Other 5, 111111111111111111111
SERIAL#: 37I iniunmmmIII Itrnnrn
`J- 7� 7) 0 9.2 •49 (if applicable) 1548109284
ERT HIGH #: / '
I ADDITIONAL INFORMATION—WATER METERS I
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: �- - � Ai.,
Date:
Original: 1-Address File
Make Copies For: 1- Utility Billing Department