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�12/16/1997 10:19 61?-633-888a FIRESIDE CORNER P�6E 05 <br /> WOOD EL'RN1NG EOUIPMENT <br /> vVood stovc with f]ue <br /> Wvod coaibination or add-on <br /> Factory Cueplace with �ue <br /> ✓Factvry Fireplace (s} Frecstanding Masonry <br /> � R►ood StOve (s) �rankiin, Other <br /> (��'�,� Btand Name �.g� ,t� (, ��, _—..__..__._.._ Modt! No. (ocbo ti G <br /> Mfgr's Min., Cfearar�ces, sid� , rear , min. ftue dia. <br /> No. Kiiehen Ex�aust dueced recizcnlating cfm, <br /> No. $ath Exhauss tmust be ducted oucside) cfm <br /> No. Othtr Fans� �ocazions c� <br /> (MUST $E APPROVED $�" �IRE MARSHAL) <br /> Installatian Removal <br /> Puel oil: gallorts underground inside outside <br /> L.P C3as: gailons <br /> �� Gas operiing <br /> ��'.� CALCULATION <br /> 1. 1.25;6 of Contxact Pricc' o.- �linimum Fee �335.00) <br /> �i�>��- � x .o12s $ 3a.oJ <br /> (contracl price} <br /> 2• �tat�Su� �* Add �he 5taxe T�uilding Code Division <br /> Surcharge to each permi�. x .0005 $ • S� <br /> or S.SO, whichever is greater irnn�rac[ price) <br /> 3. Posia¢e sfld�a�li_n_Q (Ostly rnail-in app)ications) S 1.50 <br /> a. TO'TAL PERMir FEE (Add lines 1-3 abore) $ �7_�� <br /> ' C4NZRACT'PAIC�or JO$COST mcizs �he accLal o-estin8ted doltu �unt ct►arged fot�he pe�oatted <br /> wonc iadud[ag maurials, labor. �ro.`�;, an� octer fixed costs. It is thc amounc to be chazged to rhe <br /> caatomet For Ihe work done_ If am•matcrial. equipmen�, labor, 3r inatalla�ioa are furnished by the owner, <br /> �cnant or any ocher gany the rwsonable ma:ket vaiue of such iiemr mt:st be added to thc eat}mated eost <br /> or convacc p[�iCe fot pecmit fee p�r9ose� [n the evcn; -ha� rhere is a dispuce an rhe amounr of the job cost, <br /> cAe Ciry may ieqaesc che subm�ssion�[a signed copy of the actua! concruc. <br /> " Ths STAT$ SVRCHARGE is .ORCrS .a� nc� ;on�racc price undtr SI,OOO,Q00 or 5.50 - whichevec is <br /> g[itater. For valuatiotls over Si3OC�,+Nk� ;:a1! tAe deparzment of ios,pectionat Senrices for cbt pcict- <br /> Tl�e undersigned hezeby applies cc� chc City for issuancc of a Mcchanicaf Permit, agroes to do <br /> a2I work in strict accordance with che ordinances �;f the Ciry aztd ttte regutations of ihe Minnesota <br /> Stau Huilding Code, aad certifies r}��a� aJ', scatemencs made o� chis application are compleu, true <br /> arid cotrecc. <br /> Applicarx's Sig�raaue� _����,� ; f-� - -�`_ Date: <br /> Appcoved By: Datc: <br />