HomeMy WebLinkAbout2012-00075 - water meter '" '�� CITY OF ORONO PERMIT NO.: 2012-00075
2750 KELLEY PARKWAY
OROI�iO, MN 55356- DATE ISSUED: 02/07/2012
952 249-4600 FAX: 952 249-4616
ADDRESS : 2320 GLENDALE COVE LA
PIN : 34-118-23-33-0064
LECAL DESC : GLENDALE COVE
: LOT 005 BLOCK 001
I PERMIT TYPE : WATER METER
PROPERTY TYPE : RESIDENTIAL
CONSTRUCT[ON TYPE : WATER METER
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NOTE: INSEPCT[ONS ARE DONE BY PUBLIC WORKS DEPARTMENT.
1'O SET-UP AN INSPECTION,PLEASE CALL:(952)249-4613
NEPTUNE 5/8" WATER METER-SERIAL#90496245
[RT# 1831775097
WATER METER RESIDENTIAL HORN 1 WATER METER RESIDENTIAL 1
I
APPLICANT WATER METER RESIDENT[AL 245.70
KRG PLUMBING INC WATER METER RESIDENT[AL HORN 68.97
1 168 IFFERT AVE SE TOTAL 314.67
BUFPALO, MN 55313-
(612)282-5041
Minnesota State License#: 609777
OWNER
NOZNESKY,JUST[N& SARA
2320 GLENDALE COVE LA
LONG LAKE, MN 55356-
AGREEMENT AND SWORN STATEMENT
The wurk lor which this permit is issued shall be perfornied according to
the approved plans and specifications,applicable City approvals,and the
State Building Code. This permit is for onty[he work described and does
not arant 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 atter work has commenced.
The applicant is responsible Yor assuring all required inspections are
� requested in conformance with the State Building Code.This permit may be
revoked at any time due cause.
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�C..� "�' � l � l I Z � �-
Applicant ermitee Signature Date Issu By Signature Date
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
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�/��07
o z �T t�SE oNLY �a�s
/������ City of Orono
l' � ��, P.O.Box 66 Date Received: it#a i��
��/��. ��ii 2750 Kelley Parkway
��� ����` :� �� Crystal Bay,MN 55323 Approved By:(If Required):
V\� '+ � ,��o� (952)249-4600
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CITY OF ORONO—WATER METER FORM
(*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. Ifpossible,fax in this application ahead of time; we will then cal]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 1
�Residential (May Require Approval) ❑ Commercial(Approval Required)
�New Meter � Additional Meter—For: �Replacement Meter
Job Site/Owner Information:
Site Address: ���v � �e-��n��=�k (�;�-�
Owner: �t>h�ra���� k�.��-S Mailing Address: _ �,���S �-J�z.�i�k �Iv� C.
City: �z �-f!� Zip: 5 5 3�� I
Home Phone: Alternate Phone: �7`��- `-1"1; - ,�v�j`=�
Contractor Information:
Contractor: ������ ���t. Contact Person: ����'�-� J�����=�v,'�
Address: 1� � �. �� e:, -1- t�ve S�� State License #: �{��- �vC���11t�ivl
City: ������� Zip:�/l,��1 Expiration Date: I,�- 3�- 1 :�
Phone: `�>;13 Alternate Phone:
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WATER METER PERIVIIT FEES
WILL BE CAULULATE:D BY CITY STt�F'F
S%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: �����--��V��
SIZE: �/8" ❑3/4" ❑ 1" ❑ Other " 11111111813�'��77509�71f1!I!
SERIAL#: 9 U T'� p� �_
ERT HIGH#: � � .� � � � �j (�G'/ � (if applicab]e)
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 statements made on this application are,true and correct.
Applicant: /' ��— Date: ��` 7���
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� ; ��� �Reset�Form g ��
Original: 1-Address File
Make Copies For: 1- Utiliry Billing Department I-Cash Drawer