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, <br /> CITY OF ORONO PERMIT NO.: 2010-00413 <br /> . ' 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 06/OU2010 <br /> 952 249-4600 FAX: 952 249-4616 <br /> ADDRESS : 1 105 FERNDALE RD W <br /> PIIV : 02-117-23-43-0033 <br /> LEGAL DESC : REG. LAND SURVEY NO. 0441 <br /> : LOT MB BLOCK MB <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 3,000.00 <br /> NOTE: HEAT N GLO FB-IN <br /> APPLICANT MECHAN[CAL 50.00 <br /> FIRESIDE HEARTH & HOME STATE SURCHARGE MECH(VALUATION) 1.50 <br /> 2700 FAIRVIEW AVE <br /> ROSEVILLE, MN 55113 MAIL-IN FEE 2.00 <br /> (651)633-2561 MISC FEE 0.00 <br /> Minnesota State License#: 20512060 TOTAL 53.50 <br /> OWNER <br /> BAGLEY, RALPH <br /> 602 CARTER ST <br /> C/O GEORGE BAGLEY <br /> NEW CANAAN, CT 06840- <br /> AGREEMENT AND SWORN STATEMENT <br /> I'he work for which this permit is issued shall be performed according to <br /> the approved plans and specifications,applicable City approvals,and the <br /> State E3uilding Code. This permit is for only the work dcscribed and does <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances govcrning this type of work <br /> shall be compied with whether or no[specified hcrein.This permit will <br /> expire and become null and void if construction authorized is not <br /> commenced within 180 days of the date of issuance,or if construction is <br /> suspended for a period of I 80 days at any time after work has commenced. <br /> The applicant is responsible for assuring all required inspections are <br /> � requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for.due cause. <br /> ���'l.Q-1,G �' l l C�j�Z�K l l <br /> Applicant Permitee Signature Date Issued By Si ture D <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED A <br />