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1 1111 111111 iii 1111111111111 <br /> CITY OF ORONO * 2017 - 00489 * <br /> 2750 KELLEY PARKWAY DATE ISSUED: 05/12/2017 <br /> ORONO,MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 155 WEAR LA N <br /> PIN : 33-118-23-34-0013 <br /> LEGAL DESC : ROLLING MEADOWS 3RD ADDN <br /> : LOT 001 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : GAS LINE ONLY <br /> VALUATION : $ 1,460.00 <br /> NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION. <br /> ADDITIONAL:GAS LINE FROM METER TO MECHANICAL ROOM TIE INTO EXISTING LINE,EXTEND EXISTING LINE,TEE OFF AT <br /> GARAGE HEATER,EXTEND LINE TO GENERATOR AND INSTALL REGULATOR <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 0.73 <br /> PRACTICAL SYSTEMS MAIL-IN FEE 2.00 <br /> 4342B SHADY OAK RD <br /> HOPKINS,MN 55343 TOTAL 52.73 <br /> (952)933-1868 Payment(s) <br /> Minnesota State License#:mech-MB003510 CREDIT CARD 0097 52.73 <br /> OWNER <br /> JOHNSON,ROSS <br /> 155 WEAR LA N <br /> LONG LAKE,MN 55356- <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 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 /> M ot:( <br /> Applicant Permitee Signature Date Issued By Signature Date <br />