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CITY OF ORONO PERMIT NO.: 2009-00231 <br /> 2750 KELLEY PARKWAY <br /> ORONO,MN 55356- DATE ISSUED: 05/14/2009 <br /> (952) 249-4600 FAX: (952)249-4616 <br /> ADDRESS : 450 OLD LONG LAKE RD <br /> PIN : 36-118-23-34-0014 <br /> LEGAL DESC : SUMMIT STATION <br /> : LOT 007 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 3,455.00 <br /> NOTE: GAS FACTORY FIREPLACE WITH GASLINE-MODEL#6000 GIPI BRAND NAME-HEAT N GLO <br /> APPLICANT MECHANICAL 50.00 <br /> FIRESIDE HEARTH&HOME STATE SURCHARGE MECH(VALUATION) 1.73 <br /> 2700 FAIRVIEW AVE TOTAL 51.73 <br /> ROSEVILLE,MN 55113 <br /> (651)633-2561 <br /> Minnesota State License#:20512060 <br /> OWNER <br /> MADDOCKS,R&J <br /> 450 OLD LONG LAKE RD <br /> WAYZATA,MN 55391 <br /> AGREEMENT AND SWORN STATEMENT <br /> The 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 Building Code. This permit is for only the work described and does <br /> not grant permission for additional or related work which requires separate <br /> permits. All provisions of laws and ordinances governing this type of work <br /> shall be compied with whether or not specified herein.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 180 days at any time after work has commenced. <br /> The appli t is responsible for assuring all required inspections are <br /> reques i conformance with the State Building Code.This permit may be <br /> revoke any e for due cause. 52:1 41 <br /> ,—n�,'V <br /> _/ /43� <br /> Ap icant ignature Date Is ed By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />