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CITY OF ORONO I* 21 OI it 111- I i 6 17 I* <br /> 2750 KELLEY PARKWAY DATE ISSUED: 12/07/2017 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 781 BOULDER DR <br /> PIN : 33-118-23-11-0008 <br /> LEGAL DESC : STONEBAY <br /> : LOT 005 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : HEATING SYSTEMS <br /> VALUATION : $ 2,000.00 <br /> NOTE: ALL TESTING REPORTS SHALL BE ON SITE AT FINAL INSPECTION. <br /> NEW GARAGE HEATER <br /> (1)MODINE HD60 <br /> APPLICANT MECHANICAL 50.00 <br /> STATE SURCHARGE MECH(VALUATION) 1.00 <br /> CITY VIEW PLUMBING&HEATING MAIL-IN FEE 2.00 <br /> 1880-B WAYZATA BLVD W <br /> P.O.BOX 150 TOTAL 53.00 <br /> LONG LAKE,MN 55356 Payment(s) <br /> (952)473-8793 CHECK 37469 53.00 <br /> Minnesota State License#:plbg-MB005208 <br /> OWNER <br /> GAVIN,MIDAVID&JUDY <br /> 781 BOULDER DR <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 /> 1 r ,, / 17 <br /> pplicant Permitee Signature Date Iss /6 By Signature Date <br />