2004-P07375 - vacuum breaker - Laserfiche WebLink

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SeP-04-2003 12:06pm From-CITY OF ORONO +9522494616 T-093 P.003/003 F-778 P�RMIT FEE `AT,CYJLATION(S1 2Q02 State Statute � 'Yes, This Secti�n Appiies The replaceFnent of a 1Zesidenrial fixture �r appliance that meeCs all three of the following requirements: i) Does not require mod.ification to electrical oz� gas service. 2) Has a total cost of$500.00 ar less; excI_ u_ id;na the cosL of the fi��ure or appliance: anc3 3) Ts Ymproved, instaIled oX replaced by the homeowner or licenced contractar. Skip next section; Cost of Permit $ 15.d0 Sta.te Surcharge $ .50 Nlail In Fee $ 1.50 If above does not apply, follpw guidelines below: 1. Con�ract Price* is .0125 � of job with a Mi�n2mum Fee of($35.00) 470, � .012; $ (contract pnce) (minimum$35.00) 2. State Surr.harge_ ** Add the State Building Code Division a (Minirnum Fee o�$ .SO) ��j O _ _ x .UU05 $ (concract price) (minimum� .50) 3. ��Sta�e and Handlin� (Only mail-in applicafions) $ 1.50 4. TQTAL PERMIT�"EE (Add Iines 1-3 abo�ve) $ * CONTRACT'PRIC�or]OB COST means[h�actuaI or estimated dollar amount charged for the permitted work inclnd"uig marcr"sals,labc.,profit,and other fut�d cosu. I�;s the amount to be chara4d to the cust�r�e: for tho work done. Tf any matenal, equipmene, labor,or ins�allation are furnished by the owner, tenant or any ather pai�ty the reaso�ble market value of such items mus[bc added to thc estimated GOSt or contract price for pertnit fee pLupoSes. In the evenc that there is a dispute on the amoux�t of the job cost,the City�1ay reques[tt�e Stibmission of a signed copy of the actual contract. ** The STATE SURCHARCrB is .0005 of the contract price under$1,o4�,000 or $.50-whichever is greater. For valuations over$1,000,000 cali [tie Depanment of Inspection Services for the price. The undersigned her�by applies to the City for issuance af a P�umbing Permit, agrees to do alI work in strict accardance vvith the ordinances of the City anc! the regulations of the Siate of Minnesora, and c��rtifies that alI statements made on this application are eomplete, true and carrecc. Applicant'sSignat�zre: Ul,(�L,� ��.,�,�c _ Date: o`t�o� o .