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. � <br /> . ' <br /> P1:NM1'(' PCG CALCULATION(S) <br /> 2Q02 State Statute Yes This Section Applics <br /> Tl�e replacement of a Residential fixture or appliance that meets all three of the follo���ing <br /> requirements: <br /> I) Does not require modification to electrica] or gas service. <br /> 2) Has a total cost of$500.00 or less; excludin�the cost of the fixture or appliance: <br /> and <br /> 3) Is improved, installed or replaced by the homeowner or licensed contractor. <br /> Skip next section; Cost of Permit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In �ee � 1.50 <br /> I f ahove does not apply, follow guidelines below: <br /> 1. Contract Price" is .012�%of job with a Minimum Fee o1�(�35.00) <br /> s^ ; _. ._. U• `.- <br /> � <��'Z_' <_ � x .0125 $ �=�_�, <br /> �COl1t1'8CY�1'ICG� �Illllllllllllll,�rJ�.00� <br /> 2. State Surchar6e. r* Add the State Building Code Division a Minimum Fee of(� .50) <br /> x .0005 $ � 5�� <br /> (contract price) (minimum$.50) <br /> 3. NostaQe and Handl�ing(Oizl��n�ail-in applications) $ 1.50 <br /> -� -� �c> <br /> 4. TOTAL PERMIT FGG (Add lines 1-3 above) � `;� � <br /> °CO!�'I�I�AC`I�PR ICI�ur.1013�'(1S�f ineans lhe ticlual or eslimated dollar am�iunt charged for t�he permiued�vorl: <br /> inclueiinr moteri�ils. inbi�r.��r��1iL ancl uther lized cosls_ It i�lhe amount lo be chargecl to the cusLomer tor the��vorl: <br /> d��nr. If�in��matcriaL eyuiEimenl,I�bor,or insfallation is turnishe�l by tlie owner.lenant or any other party the <br /> rcasunable mtirl:et value ol'such ilems must be added to the estimaled cost or contracl price for permit fee pu�poses.In <br /> the cvcnt lhal there is a�lispute on the amount of the iob cosC,the City tnay request the submission of a signed cop��oP <br /> thc actu�il conu�act. <br /> '"�`The S"fATE SURCHA[ZGG is.0005 of the contract�rice under$I,000,000 or�.�0-whichever is greater.Por <br /> valuations over S;I,000,000 call the Department oflnspectional Services ior the price. <br /> ��he undersigned hereby a}�plies to the C:ity(i�r issuance of a Mechanical Pennit,a�recs to do all N�ork in stricl <br /> accordance w�itl�Yl�e ordii����ces of the City and hhe regulxtions of�the Minnesota State Bui�l�line Code,and certi'fies that <br /> all statements made on this application are complete,true a�nd correct. <br /> , <br /> _....____._..� . <br /> /' o . ^ _ �% �; .. � L <br /> !�",��'L�u2 � � � C,.V �..� <br /> Applicant's Signature: -� ... �v-cz.._,� Date: <br /> Approved By: Date: <br /> Reset Form <br />