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Oct-04-Z001 09:08am From-CITY OF ORONO +8522d94616 T-182 P.004/004 F-452 <br /> �PE'r:I'�LIT�'EE CAY.CULATTON(S) <br /> 2042 State Statute ❑ Yes Thi� Sect;on Applies � <br /> The replacement of a Residemial fixture or appliance that mects all three of the following requirements: <br /> 1) Does not require modification to electrical or gas service. <br /> 2) Has a total cost of$500.00 or less; excludinc the cost of the fixture or appliance: <br /> , <br /> and � <br /> 3) Ts i►nproved, installed or reptaeed h�the hosneowner or]icensed conQactor. - <br /> Skip next 9ection; Cosi of Permit $ 1 5.00 <br /> State Surcharge $ �.50 <br /> Mail-In Fee $ 1.�0 <br /> If above does not aQply, follow guidelines below: <br /> 1. Co�tract price* is .0125% of jab with a Mini�num Fee of($35.00) <br /> J l`l���� L <br /> `T l V✓J � ?C .�125 $ � , � <br /> (conmact pricc) (minimum S3 5.00) <br /> 2. State Surchar�e. ** Add the State Bu'ilding Code Division a Minimum Fee of(S .�0) <br /> ��f�S� x .0005 � � ,�� <br /> (concract pricc) (minimun$.50) <br /> �. Postagc snd FlandlinQ (Only nrail-in applications) � 1.�0 <br /> �.j ��f <br /> 4.TOTAL PERIYIIT F�E (Add lines 1-3 above) � � ( •� � <br /> •CONTR.ACT PRICE or JOB COST mtans thc actual or estimated doilar amount chargcd for Iht permincd work including <br /> mncerials, labor,pro E'ie,dnd ochzr fixed costs. Ic is�he amount to be charged to the cu�comer for thc work done. If sny ma�erial, <br /> equipmen�, labor,or instnUation iy fumished by Ihe owner,tcnont or any othc�parry thc r.nsonaolc markct vnlue ot s��.ch ittms <br /> must bc nddtd to thc estima�zd cosc or con�ract pricc for permit fce purposes.In the event [hat thtre is a dispucc on[he amount oi <br /> [h�job cost,[he Ciry may r:q�cst the submission of a sigr,ed copy of the actual cortcrau. <br /> "'Tht S7ATE SURCHARGE is.00OS of thc con�ract prica under 51,000,000 or S.iO-whichevcr is gren�tr. For valua�ions ovcr <br /> 51,000,000 csll Itte DcpnCtmenc of[nspectional$ervices for tht price. , <br /> The undeYsigncd hcreby applie�to ehe Ciry for issuan<e of a Meehanical Permi[, agrccs to do all wor�t in SRic[accordanee with <br /> [he ordinnnccs of the Ciry and thc regulacions of the Minnuota S[ntt 8uilding Code,and ccrtifies that all rcaecmenis mad:on this� <br /> application are complete,true 3nd cotrcCL � <br /> • � • . �� 1 � ��'`�x� Date: �� � <br /> Applicanc s Sio aturc. _ <br /> Approved By: Date: <br /> y 3 <br />