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��r��►- � ,; ' ' APPLICATION FOR
<br /> . o�- ���1�"� _
<br /> �e�������� ��e�mi�
<br /> GENERAL INF012MATION
<br /> 1. Vou .�ay ayp[� 6u1 meehan<caL peamlte by malC on in peaeon a1 th¢ C1Ly o��ieea. llalled-in pen.+ita aae eubjec2 to the
<br /> yu�lage and handCtn� 6eea ehown be�ow.
<br /> 1. Vca.�iC calda wt(1 be ernt by aetuan ma1.0 .the eam¢ da� thc appCicat<on ie �eceived. PERµ17S ARE NOT VALiD UNiJI YOU
<br /> RECEIVE A PCRNIi CAfcD. UJRK 11UST N07 6EGIN UNTIL 7HE PERN17 CARD 1S YOSTEO ON 71lE JOB S1TE.
<br /> 3. Whtn any new conottiuction on ti¢modeGing ie .in�oCved, u acpanate bu<Ld(ng penmit muat be obtained.
<br /> I. ACC wunk muel be Jont in aceondanct with State ButCdii�g Codt lequilem¢n;e.
<br /> 5. A U woak �,uet be tnepzeted �aough-�n and 6ina(�. Ca U J73-1357 1I-houa noSice xeQu<ned.
<br /> 6. Houee Heating Teat Recond muet Lt euba<tZed be6oae 6inal - aee attac4¢d.
<br /> INSTRUCTIONS Co,�pC��¢ uL� lteme on Zhia appL,ication. Compute the peam<t 6ee. Sign and date .thc cent�6<catton.
<br /> INCOHYlE7E APPL1CA710NS W1LL NOT BF PROCESSFV. 76 you havc Qut�ilone, caGL /7)-7357
<br /> UTALK- 7N VERh17TS App.2y a.t C�,.t� U� {��.ce•s , 1335 Sau�h Bnown �oad EC.ty. Rd. 146 )
<br /> MAIL- IN PERh1I7S F��e�.aae �ee - Ma.�.2 �o : P. O . 8ox 66 , Cnya.ta.� Bay, Mn. 55323
<br /> # � * * * * * * * * * * * * * � * * * ** 7k * ak* 7k* ik***7k **il: �** ik**ik*ik*it**7k****kik* �ikikk�k***ik **ikik** ik*** ik ***
<br /> JOB SITE
<br /> Oceupancy Type: aee4 ¢ �aL co�■encia[; Othea
<br /> J .
<br /> Owner ' s Name �- - P �f j",�tf'�
<br /> c� C" �, � Tele hone Numbe
<br /> Mailing Address � �� � i►r����, �"''�i �--"� 4 ► �
<br /> �... , �r�,��'�
<br /> Contractor' s Name ��� t ' ; ; `:, � "��,f' ! �°; � •y;'s, Telephone Number
<br /> f ;
<br /> Ma i l i n g A d d re s s ) ` �� �/�.� �'�._�7 '7'".�? , t.: s r�� ,•`� � r 7`t� 4
<br /> ******K***************x*�******************�:**�**�*****************************
<br /> HINIMUH FPE (520.00 per pzoject)
<br /> ..........�........................�...•.�...��..�.•......�a.............•..........•.........•••.•�••...••...•�•...•...•...
<br /> HEATING SYSTEHS $15.QGench unit
<br /> FUEL nnt. gau, ^ lp g�s, � oil, _ clect.
<br /> other (spacify if canbination burncr)
<br /> EOUIP. (if more than 1 unit per bldg., list cach eeparatcly)
<br /> No. Type Dt�h Input Drand Name Model No.
<br /> f. a. furnace
<br /> hv boiler '
<br /> unit heater ,
<br /> soler h[g. c
<br /> _ equiprnent YSU.U�each system Total
<br /> .................................r..........,..................�............................................................
<br /> AIR CONDSTIONINC $15.00 encn un�r
<br /> Cenczal Air _ Separatc Central Air System
<br /> "� w/furnacc
<br /> Brend Name ltodel No. Tons Total
<br /> .........................�,.....�..........�..�................�...a......� ....•.•........�....•r�.......�.................•.
<br /> HOOD i�uR1ING eOUIPhi£t:T (atta py of mfgr's installation spocs.) $LS.0 U ench unit Wood stove vith flue
<br /> �b $30.QQ each �nit wootl combination or add-on unit
<br /> Fnctory� Fireplacc(s) frcestandiny built-in e15.�� each unit factory fireplace �+iLh flua
<br /> Hood Stove(s) frenklin, other Y .
<br /> q �__ _
<br /> Brend Name � 9T""`� � C" Model No.
<br /> Hfgr'• Min. Clearances, side , rear ("� , Min. Flue Din. 4, '� Total � ,� i
<br /> •���•.•������...��...•.•...�..�.�.����������r���y��•.�����a�������.�•�e���.�•�����a�.������������������������������s�������•
<br /> �'r+T13i2ION - 5 5.00 each exhaunt fans (bath, kitchan,
<br /> No. � Y.itchen Exh�ust _ du.:ted _ recireulatin9 _ cfm attic, ete.)
<br /> No. �_ ➢ath Exhaust (must be ducted outside) _ cfm
<br /> No. Otner Fans: Locations cfm Totul
<br /> .................................�..•..•....�..•�«........•.a•..�...............•.r•.�...•�..��-..�.�•.......�•..�....•.....•
<br /> FUFi. sToanG� (must be aE�proved by fire m�rshal)
<br /> _ Fuel Oil, q�lluny _ undergroun� _ insidc _ outside
<br /> Lp Gas, yallons
<br /> O[her,
<br /> ........................................................................ . . ... .... ...................
<br /> sNrttri�;rFn SYS^-�w,s ) a) •r.i=siiietlti�l $20.00
<br /> ($�0.00 minimum; $10U.00 maxiniuni)
<br /> Nu,�ber of Heads No. of Risers b� Commercial �2�.00 Plan Review
<br /> Type ol Sys�em (3 sete of pl�ns requirecl for revie�a) $2.UO per head Tnt�l
<br /> •��••�••�.��•�...•.•.�..a..�•���e��a.��r.����a���i�a����a����.�a.�����������.�������a�r��������a������r��������������������•
<br /> Coirvnercial, Industrial c Multi-Family cen Fee Schedule
<br /> PERMIT FE� CALCULATION
<br /> 1 . Total of ahove Installations or P�Iinimum Fee (�20 . 00) � $ �
<br /> 2. State Surcharge Add the State Bu<Cd1ng Code Dlvlalon Suachaagc to cach peaw<t $ . �j�
<br /> 3. Postage c1I7C� Handling On aCC na<Led-in appCicat�.one, adC the poeZage aeid handCi.ng 6et $ l. OQ
<br /> 4 . TOTAL P�Rr�1IT FEE add �tnee �-3 abovc, $
<br /> k¢ unle.tieign.d heneby nypllca tu tlie C.ity oa Oaono 601 iaeuance o6 a Ilcchanical Pen��i;, aga¢e♦ to do aCG wolk in ♦talet •
<br /> ccoadar.cc with tli¢ oadinancc� 06 the CLty and tlie Regulattone o6 Lhe llinneaota State (1u<Cding Code, and eenti6iee that
<br /> [( etaLe�nenle eade on Lhia appCicatlon d.te compLete, taue and conaect.
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