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11/08/95 11:41 THE CITY OF ORONO 612-473-7357 003 <br /> SOD BURNING EQUIPMENT <br /> Wood stove with flue <br /> Wood combinat ion or add-on <br /> Factory furplace with flue <br /> factory Fireplace (s) _ Freestanding _ Masonry <br /> __ Wood Stove (s) Franklin, other _ <br /> Brand Name Model No._ <br /> Mfst-'s Min., Clearances, side rear inin. flue dict. _ <br /> VENTILATION <br /> Nu. Kilcliell Exhaust ducted recirculating cftn <br /> No. Bath Exhaust (must be. ducted outside) cftn <br /> No. Other Dans: Locations _ efin <br /> FUEL STQRA,GE (MUST BE APPROVED 13Y FIRE MARSHAL) <br /> Installation Removal <br /> _ Fuel oiler gallons ^_ underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Cotltract Price* nr Minintut c 5.00 �-1,� <br /> -?(}:,t� x .OI25 $ —3�.- <br /> (contract price) <br /> 2_ State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. 2uc x .0005 $ _ _ <br /> or $.$0, whichever is greater (contract price) <br /> 3. Postage and. IIandlitig (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 3(8. L:: n _ <br /> * <br /> CONTRACT PRiCE•or JOB CUSP mc:nts (tie actual or estiillattxt dollar aniouut charged for the permitted <br /> work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the <br /> customer for the work clone. If any maletiial, equipment, labor,or installation are furnished by the owner, <br /> Icnant or any other party the reasonable market value of SUGl1 items must be added to the estimated cost <br /> or contract price for pernUl fee pi pQses. In the event that ihcrc is a dispute on the amount or the job cost, <br /> the City inay request the submission of a signed txpy of the actual conirwt. <br /> ** The STATE SURCHAROF. is A=3 of the contract price under $1,000.000 or 1:.50 - whichever is <br /> greater, For valuations over$1,000,000 call lite Department of Inspectional services for the price. <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do <br /> all work iti strict accordance with the ordinances of the City and tate regulations of the Minnesota <br /> State Building Code, and certifies that all statements rnadc on this application are complete, true <br /> and correct. <br /> Applicant's Signature: I <br /> Date: / <br /> Approved By: Date: <br />