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. :�3 ;:� <br /> ' CiTY OF ORONO ' � 612473051D 02/21./97 15:28 � :03/03 No:39b <br /> ; . . . . <br /> �. �. �� . � yVoad stove witl� flue .� � . . � <br /> � . � . 'Wood combination or add�on . . . � . <br /> �� �. `� Factory.fueplace with flue � . , �� . . .. . <br /> . � � . ___�__ Factory�Firepl8ce (s� �,� Freestandin,g ,____�; Masonry � <br /> . . � . � . � Wood Stnve (s) � � Frankiin, ot�er ` . <br /> . . . � $rand Namc `�i_.T���:. L�`��Y�' �� Madel ND.� vC ,�;��_'I (�-��f'�.( � <br /> .. ,... � <br /> . Mf�r's.Iv�in. Clearanc,�s; side�_, . r�r ,_,�,, triin. fiue dia. ��_ <br /> � . . . . . . . . �'{ . . . . �. . <br /> � .X�Y'�ATIQ�1 . . <br /> No.. IC�tcben Exhaust ducted recuculat;� cfm <br /> -..,_..� .�-�— <br /> : : No. „�,�, Bath Exhattst Fmu&c t�e ducted outside} � cfm , <br /> . PJo. Other:Fans: �ocations cfm � <br /> . . _..__t_ <br /> � F�� S R.AGE (MUST� BE APFR�VLD BY FIRE MARSHAL) � � <br /> instsUatian R�moval <br /> � <br /> F�el flil: gallons T� underground inside outside <br /> LP Gas: � �llons <br /> . . . Other Gas opening <br /> PE�'�'T F��CALC�7LATION <br /> 1. :.25°k af �gn�aet Pzice'� or h�lin3m�tm Ree (535.04) <br /> `� �" ,�C,L., x .0125 $ ����, ��.� <br /> icolut�cz pnca) <br /> 2. St�tc� arge. ** Add the �tate Building Code Aivisio� <br /> � � . . Surcharg� to eacYi �rmit. x .00t?5 $ ,yZ.,(,,;t <br /> . or $.50, whichcv�r is groater (wacrau.pr.IcG> <br /> . 3. �o�Ea�� �nd a:�dl�ne (Only �naif-in applications) $ 1.54 <br /> � 4. TOTAL PER'VLIT �EE (Add lines 1-� above) $ .���;` <br /> * COTJ?RACT PRICE or JOB eQST mcans che actual or est�maced doUar amoun� c;hatged for.the pecmicted <br /> � �. worY iaciuciing a�ateri�is, labor, psofst, sr.d other �od cosu. lt is che uYnousu rn be charged, to the <br /> . : . customtr.for tlle�+o�ic da�e: if any mace�iat; cquipmr.�t. labor, or uutallatiau 3re furn�shed by the ownar. <br /> . � � � . senant or any other�rcy the re�so�ble marYrc value of such itema must be added W the estia�eted cosc <br /> � . � � or contraet�rir�for permit fee purposes: I�che evenz ttuu t�ere i9 u dispnte on the amount of che job easc. <br /> � � chb Ci�y may requesc �he submission�f a signed copy ot the act�a! conuacc. <br /> �� .The STATE SUttCHARGE is .0005 of zhe cpntract price unda $1,OQ0,000 or S.50 - wbichever is <br /> � � � �reater. Fo�v,alu�cions over 51;000�000 calt the Dopactmau of Tngpeaioeutl Servic.�s for, the price. <br /> � The�:unciersig.�ed her�by. applies ca che Cicy for issuance of a Mechanical Pe;mit, ;�grees to d.c� <br /> . . , aiI wock in strict ac�:ordance with the ord'u�ances of t1�e�City and tbe regularions of tl» Minnes�ta <br /> . ��5i�� �uilding Code, and e�rtifies that all statemeuts.macie on this applicatian are complete, true <br /> . and.corrr.ct. <br /> � <br /> : � A.�plicant's Signature:- � � Date: � C` . <br /> � � � <br /> > . <br /> � Agproved By:. . Date: <br />