|
12/05/2014 10:26 7635354379 GOLDEN VALLEY HTG PAGE 01/64
<br /> �......... ...... . ... .
<br /> �:
<br /> ,,,.. ,..,,. > .
<br /> ..:.. .
<br /> ' � ,�,:::"' ��:;::> �; :. : .. ,
<br /> ........:::..:... ...:.. .:... '. � _
<br /> , . :. ,.��A
<br /> RNIl'f FE
<br /> . .„,...
<br /> ULAT'[9�T(S),, �
<br /> . .........::.. ,-: ;:..: ..... SED O�'F ::2002.5'�'ATE;�'X'A`�UE,.
<br /> ❑ Yes,this section applies
<br /> 7't►e replaCement of a Residerttial fixture or ennliance that meets all thrcc of the following requirements:
<br /> 1. Does not requi�e modification to electrical or g�s service.
<br /> 2. Nas a total cost of$500,00 or tess;excludine the cost o�the fixture or appliance:and
<br /> 3. Is improved,instalied or replaeed by the homeowner or licensed coniractor.
<br /> Skip next section,if this applies; Cost of Perr�pt $ I5.00
<br /> State Surcharge $ 5.00
<br /> Mail-In Fee([f Applicable) $ 2_00
<br /> Total�ermit Fee $
<br /> ....:.:. ...:....:
<br /> ��: �.:,�.�,�.. .,. ; : ;:;,:PERl1!�T�EE CA►LCi��,.A:T�ON S --rOBS OVE�t$500.00 �
<br /> xf above does not apply;follow guidelines below:
<br /> i. CONTRACT PRICE *is �_2S%of contract price with a(Minimum�'ee of 550.00)
<br /> d� x.0125$ �� �
<br /> (contrac price) (�uioimum 550.00)
<br /> 2. STATE SURC�#ARGE A,,,l !,
<br /> •' � VV x.0005 $ � i V�
<br /> (connact rice)
<br /> 3. POSTAGE&HA,NDLING(Only on Mail-ln Applications) $ 2.00
<br /> 4. TOTpL PERN(]T FE�(A,dd Lines 1-3 Above) $ \ �C,���
<br /> ` * CONTRACT P�tzCE or JOS C05T means tho actual oc estimatcd dollar ampunr chargcd fo[tk�e
<br /> permitted work ineluding materials,labor,profit,and other fixcd costs. It is tho amount to be charged
<br /> to the customer for tbe work done_ If any material,equi�ment,labor or iqstallations are furnished by
<br /> the owner,tenant or any other party,the reasonable market value of such items must be added to the
<br /> estimated eost or contract p�ice for pernr►it fee purposes. In the e�ant that chere is a dispute on the
<br /> amount o�'the job Cost, the City may request the submission,o#'a signed copy of the actual Contract. �
<br /> � , ,,.,,.,:.�........:: :::::„:;....:
<br /> ,,. � .'. - -�CHYIN�C;A,�;'PE T.APPI:I�A'I"T�N q,
<br /> .:. .:........:... G�EEIVI�NT
<br /> The undersigned hereby applies to the City for issuancc of a Mechanical Permiit,agrees to do all
<br /> wo�rk in strict accordance w�ith the ordinances otF the Ci�ty and the regulations of the State of
<br /> N�innesota, a�nd certifies that a�l statements rr�ade on this application are eompfete, true and
<br /> correct,
<br /> Applicarr�'s Si ature: � L "'r`''� � /� /
<br /> 8� Date: �
<br /> 3
<br />
|