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CITY OF ORONO PERMIT NO.: 2011-01135 <br /> 2750 KELLEY PARKWAY <br /> ORONO, MN 55356- DATE ISSUED: 09/29/2011 <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 55 WEAR LA N <br /> PIN : 33-118-23-34-0006 <br /> LEGAL DESC : ROLLING MEADOWS 2ND ADDN <br /> : LOT 002 BLOCK 001 <br /> PERMIT TYPE : SPRINKLER <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : LAWN SPRINKLER <br /> NOTE: INSTALLED BY OWNER-MICHAEL KELDERMAN <br /> BACKFLOW DEVICE-PVB <br /> MAKE-ZURN, MODEL 720A YEAR OF MANUFACTURE-2011 <br /> 60 RAINBIRD HEADS <br /> APPLICANT SPRINKLERS 35.00 <br /> KELDERMAN,MICHAEL&JUDITH J STATE SURCHARGE FLAT-OTHER 5.00 <br /> 55 WEAR LAN <br /> LONG LAKE,MN 55356- MAIL-IN FEE 2.00 <br /> MISC FEE 0.00 <br /> TOTAL 42.00 <br /> OWNER <br /> KELDERMAN,MICHAEL&JUDITH J <br /> 55 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 goveming 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 conforman e with the State Building Code.This permit may be <br /> rev d at any time ford cause. <br /> 9, - 77, /1 of , , 62aLea/‘.._ <br /> Applicant Permitee Si ure Date Issu=f:y Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />