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CiTY OF ORONO � b12?494616 04/22/99 13:48 � :03/05 N0:837 <br /> ' �00�,� ' <br /> �, Woad Stave wikh flue <br /> ______ Wood cornbination or add�on <br /> P�ctpry fireplace with flue <br /> Facct�ry l�ireplace (s) _..._._... Frcestanding MM�ssoruy <br /> VVood Stt�ve (s) Franklin, oCher <br /> Arand Nazrie __ _ .�..�,.. Model No. <br /> 1bYfg�•'s Min., C�earanc;es, side o rear.�..__, min. �lue dia. .'�.,.T <br /> �.�'.��[ <br /> No. � ]�itch�n Exhaust _ _ ducted reciraulating �F� <br /> Na. Bath �xhaust (must be ducted outside) cfm <br /> IVQ. Other ��ns: �...ocations cfrn <br /> '�'r�r ��S?�ASE (MUST BE APPROVEp BY F'IRE IVIARSHAL) <br /> Installatian Removaf <br /> „_;.� �'uel ail: gallana und�rground inside putside <br /> i1P l3as: _._� <br /> gallo�s <br /> 6�ther Gas opcning <br /> � l�t <br /> I. 1.25°,� vf��t,�' i e* or ����g��� <br /> - - � ���.v� x .Q125 $ ���,,�,� <br /> ^ (Cacuracc price) . <br /> �� �,.�,�1},1�"g�;, ** Adci the Stace $uilding Ccde Division <br /> Surch,ar$e to each permit. l ` ;���C'� x .0045 $ ,�_ <br /> car �.50, W�iC�l�v�l' iS �i'Cate� (contract pCice) <br /> 3• �'ast�ge and Han �ina (Only anail-in applicatfon�) $ �,�Q <br /> 4, '�"OTA� PERMIT F�� (Add lines 1-� above) $ :-.�_?,��, <br /> * CpN'iRACT PRIC�or JC78 COST�ncRn.a che actaai or escimaced dollar amounc ohargo<I for the p�ermitced <br /> work including �naterials, Eabor, profit, and ott�er fszed coats. It is the amouat tp be chargcd to the <br /> cu:stomer far the work donc. 1f any matezial, equipa�er�t, labor, ur ins�allacion arc furnished by the owner, <br /> ucxant or�ny otber party the reasonable market valu� of euch iten�s muyt be added lo ihe estimated cast <br /> or cc�nCrxcl prica far permit iee purpc,ses. in t�C e+vGnt thut thcre is�dlspute on thc �ntpunt of the jab co4t, <br /> the City may request ehe submission of a aigned copy nf the actual contract. <br /> "'" The STA'C� SURCHARG� is .0005 of the coatract prfce undec $1,OOp,000 or 5.50 - whichaver is <br /> greatcr. Far valua[iens over $t.Q00,00p calI tha Deparcment of Inspectfonal Scrviccs Por the pricc. <br /> The unders�gn�d hereby applies t� the City for issuance nf a Mecharlical permit, agr�es to d�:� <br /> all work in strict accc�rdartce with che ordinar�ces of ttte City and Che regulations of che Minnesota <br /> SCate Buildirtg Code, and certifies that all siatements made an this xpplication are complete, true <br /> ,and correct. <br /> Applicant's Signalure: �� �.� g �____^ Date: -�`� -_� <br /> � � <br /> A�pr�ved k�y: �� w ..�,.....�,.�........._.�...,1_ Date: <br />