HomeMy WebLinkAbout2012-00485 - water meter jo � CITY OF ORONO * 2012 - 00 9 5
2750 KELLEY PARKWAY DATE ISSUED: 06/04/2012
ORONO, MN 55356-
952 249-4600 FAX: 952 249-4616
ADDRESS 3645 TOGO RD
PIN : 17-117-23-31-0034
LEGAL DESC TOWNSITE OF LANGDON PARK
LOT 006 BLOCK 010
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
NEPTUNE 5/8"WATER METER-SERIAL#89835046
ERT# 1831392115
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
APPLICANT WATER METER RESIDENTIAL 245.70
ZHUK,ROMAN&ELENA
3645 TOGO RD WATER METER RESIDENTIAL HORN 68.97
WAYZATA,MN 55391- TOTAL 314.67
PAID WITH CC# 3409
OWNER
ZHUK,ROMAN&ELENA
3645 TOGO RD
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 respons le for assurin all required inspections are
requested in conf cc with the udding Code.This permit may be
revoked at tfor due cau
App ' ttee S' ature Date Issued By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
Af
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�� ,u� P.City of Box Orono Date-Rec �' Permit=# 26
` 2750 Kelley Parkway
asJ, Crystal Bay,MN 55323 ApprovedBys(IfRequned):
(952)249-4600
CITY OF ORONO–WATER METER FORM
(*Note:Some permits may require approval by the Building Official and/or Public Works Department*)
GENERAL lIff{JRMATION
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) 2494600,
upon completion of meter installation.
TYPE OF1PERIVITT
`Cheek A;II'TIIat Apply-)-' '
1
Residential(May Require Approval) Commercial(Approval Required)
New Meter Additional Meter—For: Replacement Meter
Job Site/Owner Information:
Site Address:
Owner:l!-2 2� Mailing Address: 00 e k F&Z ?
City: /Cl^eL-eOC-IA Zip:
Home Pho/nob S Z �� 9P Alternate Phone: �—
Contractor Information:
Contractor: ,contact Person:
r
Address: % r State License#:
City: ,.zip: - Expiration Date:
Phone: r` Alternate Phone:
"METER- ❑ 3/4"METER- 1"METER-
5/8"HORN - ❑ 3/4"HORN - ❑ I"HORN -
❑ 71
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: A" `�-
SIZE: -65/8" E13/4" ❑ 1" ❑Other'(' "
SERIAL
ERT HIGH#: _ IIIA j83nllll�115111111 (if applicable)
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,and certifies that all statemen ade on this application are,true and correct.
Applicant: Date: 7 Z-
100,
Original: 1-Address File
Make Copies For: I- Utility Billing Department 1-Cash Drawer