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1111111111 Hull]= <br /> CITY OF ORONO * 2012 - 01160 * <br /> _A 2750 KELLEY PARKWAY DATE ISSUED: 11/13/2012 <br /> ORONO, MN 55356- <br /> (952)249-4600 FAX: (952)249-4616 <br /> ADDRESS 1560 TANGLEWOOD RD <br /> PIN 26-118-23-32-0012 <br /> LEGAL DESC TANGLEWOOD <br /> LOT 003 BLOCK 001 <br /> PERMIT TYPE MECHANICAL(>$500) <br /> PROPERTY TYPE RESIDENTIAL <br /> CONSTRUCTION TYPE : FIREPLACE-GAS <br /> VALUATION : $ 7,800.00 <br /> NOTE: (2)GAS FIREPLACES-HEAT N GLO-MODEL#ESCAPE I30 <br /> APPLICANT MECHANICAL 97.50 <br /> FIRESIDE HEARTH&HOME STATE SURCHARGE MECH(VALUATION) 3.90 <br /> 2700 FAIRVIEW AVE <br /> ROSEVILLE,MN 55113 MAIL-IN FEE 2.00 <br /> (651)633-2561 TOTAL 103.40 <br /> Minnesota State License#:20512060 <br /> OWNER <br /> BUHMAN,DION&TANYA <br /> 1560 TANGLEWOOD RD <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 /> 111 /3 i /�- <br /> Applicant Permitee Signature Date ssu By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />