Laserfiche WebLink
� • <br /> „a_.BUR'�IL'�1G_�2U1PNfENT <br /> Wo�d stove with flue <br /> Wood cambination ��r add-on <br /> � Factory fire�lace with f�ut <br /> _ _ Factory Fireptace (s) Freestanding X__ Masoruy <br /> Wood Stove (sj _ __ Franl:lin, other <br /> --------- ----— -- <br /> �3rand Name Mod�l No. - _ _ <br /> Mf�r's Mir�., Clearan�cs, side f , re�r�__, IT11I1. fIU��i3. ______ _`_ <br /> rrDt:�t <br /> � :�:� � ta...��7��c��N <br /> _____.�. <br /> N�. Kitiliea� Exhaust ducted recir.c��lf�ring -- ---- c.tm <br /> N�. I3a�!► Exll�ust (must be ducted outsidej cfm <br /> :�'o. --f.- Other Fan:s; L<�cations cfm <br /> - � __ fotat <br /> �"1 ►RAGE lMUST BE �APPR�VEU BI' r'IRI: MAItSHAL) <br /> ..iilacivn Re►3�t7va1 <br /> �'uel oil:�� gallans __._ ur3der�round _�____ �r�s�de — -- oucsicl� <br /> .__.. l.P Gas: gallor�ti <br /> Other l�as c�per�ng <br /> s � �"EE CALC:UL�IT�ON <br /> 1 � �5`Tc of Contraci_Yrice* or :1linimum Fee t$35.00} <br /> �3.3 Ov " �: .0125 `� �/� c�S _ <br /> -- -------- <br /> --�-- <br /> . (rontra�,t pncej <br /> 2. 5tate_Si�rchar e. ** ��dd the �ta[e F3uitcling C.ude T�ivisit�n <br /> Surcharge [o each peny►it. ---- '�33a6-- x .(}i)�}5 � --�.6$� <br /> (co;�tr�ct Fiice) <br /> ��T �, jC?. whichever is greater <br /> ti, r'r,.�ta�� and Handlin� (Otlly iilail-In ���li4atic�FiS) $ �_1.SU _ ..._ <br /> 4 TUTAL YER?�11T F�E (Add lines l-3 abovel a yy,� y0 _ <br /> '� C'UNTRr1t.-� PRlCE or 306 CUST means the actual or estim��r.cJ �lc�li�a attlount chargcd fv�thr pernuttcd <br /> wnrk �nciudin� materiats, 3abor, pro1�1[, and otheT fi�ed cnsts. Ii is i2�c �uuuu�i� �v uc chargcd co �hc <br /> �ustomer tor the wark done. if any�materia(, cqut�7rnen[, lahor, or instaIlatic�n arc lun��ai�cd ��y trEc owner, <br /> �e�n:�nt or any other Pany the reasonable marke[ v�lue of suc:h iir.nu u�u�� l�r. �added co chc csnmaced cos� <br /> or contract przce for permit fee putposes. In the event thac therr is a d�spute on the amc�unc uf tEie�ob cosi, <br /> �he C.��y rna� re�uest the submission of a signec3 co�iy of the act►�al caneracc. <br /> "` Ttie STATE SIJRCHARCiE Is .U045 of ibe contCact pricc u::_..cr �1,UOO,OCIC1 �,t 5_SU - wh�ctic�c� �s <br /> grcalet. I=eiC v11uZt�ons pvcr $1,cX10,OC1Cl call tt�e llep�utn�ent ot Ins�rcciior�al ��er��ces fur [he price. <br /> The unciersi�cicil lye�cby ap��lies to tt�e Ciry for issu�nee of a Mechanic;al I'c:i'Jnit, agr�es to u�_ <br /> ali work in strict accordance with the ordinances of the Ci' and [he regulaiic�ns ui the Miru►c r.;x <br /> State Duilding Code, and certitiec that all st�tements m�ttiL uu t�iis applicatioii arc i:<�mplete, <br /> ancl currect <br /> Appficant'sSignarure: `j�p,G� Q-.��.2dh i)ate: �///�3/qy_ <br /> Ap�+roved By: - _� _.�_ ..�_� - - - - - ___ - -- Datc.. - — __ � <br />