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, L <br /> CITY OF ORONO * Z 0 1 3 - 0 0 3 9 9 * <br /> • " 2750 KELLEY PARKWAY DATE ISSUED: 06/03/2013 <br /> ORONO, MN 55356- <br /> (952) 249-4600 FAX: (952) 249-4616 <br /> ADDRESS : 495 OXFORD RD <br /> PIN : OS-117-23-41-0011 <br /> LEGAL DESC : STIELOWS ADDN <br /> : LOT 003 BLOCK 001 <br /> PERMIT TYPE : MECHANICAL(>$500) <br /> PROPERTY TYPE : RESIDENTIAL <br /> CONSTRUCTION TYPE : MECHANICAL-MULTIPLE <br /> VALUATION : $ 80,419.00 <br /> NOTE: GEOTHERMAL <br /> (1)CARRIER-NATURAL GAS-PVC- 120,000 INPUT, 115,200 OUTPUT - 2200 CFM <br /> (1)CARRIER-NATURAL GAS-PVC- 100,000 INPUT,96,000 OUTPUT - 2200 CFM <br /> (2)BOSCH COOLING SYSTEMS-6 TONS <br /> APPLICANT MECHANICAL 1,005.24 <br /> FLARE HEATING&AIR COND STATE SURCHARGE MECH(VALUATION) 40.21 <br /> 9309 PLYMOUTH AVE N <br /> SUITE 104 MAIL-IN FEE 2.00 <br /> GOLDEN VALLEY,MN 55427 TOTAL 1,047.45 <br /> (763)542-1166 <br /> OWNER <br /> SAMPLE,MIKE&ANNE <br /> 1449 BAY RIDGE RD <br /> WAYZATA,MN 55391- <br /> AGREEMENT AND SWORN STATEMENT <br /> The work for which this pertnit 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 aze <br /> requested in conformance with the State Building Code.This permit may be <br /> revoked at any time for due cause. <br /> ��-.� ��.�- � , � � �3 � � �� <br /> 'Applic t Permitee Signature Date Is By Signature Date <br /> SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. <br />