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r <br /> 06�13i95 11:57 THE C1T1' OF ORONO 612-473-73�7 0�3 <br /> � , . <br /> WO "G <br /> Wood stove with flue <br /> � Waod combination or add-on <br /> Factory fireplace with flue <br /> Factory �ireplace (s) � Freestanding Masonry <br /> Wood Stove {s) Franlclin, other _ <br /> Brand Name Modei No. <br /> Mfgr's Min., Clea�•ances, sidc , rear , rnin. T�, <br /> VE II.ATION <br /> No. Kitcuen Exhaust ducted recirculating cfm <br /> N�, gath Exi�aust (must be ducted outside) cfm G�m <br /> �o. Other Fans: I.ocations <br /> Tatal <br /> FUEL STOI�iG� {MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation x Removal <br /> �� Fuel oil: fO�Q gailo�ns i� underground � inside � outside <br /> LP Gas: �� gallons <br /> � Other Gas opening, <br /> P�RMIT FEE CALCULATION <br /> 1. 1.25% of Contr�ct Pris�* or Mini�wtt �ee (��Z 5 �� <br /> (D�O. OD x .0125 $ -3 <br /> (cvcaract price) <br /> 2. S e Su har e ** Add the State Buitding Code DiXisio�s � , 5O <br /> Surcha�ge to e�cl� permit, _„� - <br /> (wntract pricc) <br /> or $.50, whichcver i� $reater �5� <br /> 3, os anci Handlil� (Only mail-in applications) $ <br /> 4, TOTAL PERMIT FEE {Add lines 1-3 above) $ . 3���� <br /> + CONTRACT PRICE or 30B COST means the�tuai or estimated doitar amoune c:haxgcd for tt�c per:nitted <br /> work iucluding materials, labor, profit, and other fixed costs. It is the amount to bc cLargcd to the <br /> customer for the work done. If any matenal, equipment,labor,or instsllation are furnished by t5e owner. <br /> unant or any other parry the reasonable market value of such items must be addcd ta t1�e estimatat cost <br /> or contract price for perndc fee purposes. In the event that there is a dispute on the amount of the job cost, <br /> the City may requast the submission of a signed copy of the actua� contract, <br /> *rt T'!�c STAT� SURCHARGE is .0005 of the w�.tract pnce undtr 51,000.000 oc $.50 - whichaver is <br /> greatec. For valuations over $I,OOQ,000 call the Dcpertment of Inapeetional Scrvices for the priee. <br /> The undersigned heroby applies to the City for issuance of a Mechanic:al Permit, agress ta do <br /> all work in strict accordance with the ardinances of the City and the regulations of the Minnes�ta <br /> Sta�tc Building Code, and certifies thac ail statements made on tlus a�plication are con�P[ete, truc <br /> amd correct. , � � <br /> 's Si naturc: r pate' —L'- 3 g <br /> Appt�cant g � <br /> Approved By: -- Date: 1 <br />