|
02/17/1998 �8:35 61�-633-8884 FIRESIDE CORr�ER PAGE �3
<br /> ` µ . ,..'
<br /> . . �..
<br /> WOUA g��G �OtJIP� -_ >::
<br /> Wood.stove with ftue �
<br /> Wood combination o� add-on - ; : ; - ;
<br /> , .
<br /> Factory'�'iirep'la�ce wirh flue .
<br /> . _ � ;.
<br /> �_ Factory' Fireplace (s) �T__ Freestanding Masonry
<br /> ,
<br /> �Vood.Stave (s) l�r<inkliza, other -'
<br /> �'C�-a– Bra�d Name ��. ,a� �.��rL�_:.._.._ __�_u�-.__ -- Mode1 No. �rc�:�:� 7�r�� ;
<br /> Mfgr's Min., Clearances, side_ , ru�r min. flue dia. �
<br /> - _—W�.� '
<br /> , , ,
<br /> T� `-3,c ;u�� `�.:
<br /> .
<br /> . _;
<br /> vENT3T.�'�4N -..:�
<br /> = �
<br /> I�o. Kitcbeit Exha�st _ ducted � recirculating c�arn -_:
<br /> No. Bath Exha�st (mus� he ciuctE.d outsidej cfna
<br /> No. Other'Fa�: ' Loc��do�as cfm : :
<br /> ,.._
<br /> .
<br /> Total
<br /> �'iJEL STORA,GF (MUST BE A�'PFt()VFn I3�' k��IF�: MA�2SHAL) �
<br /> . ..
<br /> installstion Remvval
<br /> �uel oii: gallons _..._`._ undec��round inside out5ide ,: ;
<br /> LP �as: gallons ' °�:,
<br /> ,..
<br /> �Jther Gas apezzix�g . `.�.
<br /> , .
<br /> . , ..
<br /> ,.;
<br /> PERMIT �'EE CAZ.CULATI,f}1�T
<br /> l. 1.75% of'COrltract �rice oz �'Iin�m m Tec 'i5.Ot1 - �'. .
<br /> * __�. u.__ '_�._._..� -
<br /> ,�:�c'C�.c^:> X .�12$ $ ..`-i,J�'�
<br /> _��:. �:_ :.
<br /> (contract price) -- -,.
<br /> �.
<br /> 2. Staie 5utch�� "`* Add the State Buildin� Code Division : '.`
<br /> Surcharge �o eack� permit, ra��.C��.��z> x .0005 $ /.t c� -_:
<br /> _— _� ____.. - --
<br /> _ (contzacc price) - .: _.-
<br /> , ,
<br /> oz $.50, whichever is gaceater ''.
<br /> :�.
<br /> 3_ pos�a�e ana Haadl'u�� (o�iy rnail-in applicat���ns) $ �-�-�'� - �.
<br /> 4. 7'flTA,L PERMIT FEE (Adci lxr�es l-� ahove) $ 3Cr•C.o . �
<br /> * CONTRACT PRICE or70B COST me:uls the acnx�) nr c�timated doltaz amount charged for the permitteid -
<br /> ,:.
<br /> ,::
<br /> work including mate�rials, lahor, profit, aaid c��ber fixed costs. It is the amount to be chaxgtd to"the - ; =
<br /> cusrome.for the work do2te, Tf any n�:ru:ri.�1, ��ctiril�n�e�zc, I:�hor, or Installation are fumished,by the ot��nez� ' .
<br /> _ .;,
<br /> cenazit or a►�y a[her patty the zeasonabac nnarke� valuc oi such ite�ns must bc added to tk�e estimated eost `: -.' , -
<br /> or contract�rice foi permit fee purpo��s. ]»tbe e��cnt;h;�t th�re is a dispute on thc amount of tA�job Cost, '-
<br /> the Ciiy tnay,re�uest the submission c�f a si�ned copy of ihe actual conctaet. -
<br /> . ..:;.
<br /> *'" The,STATE StJRCHAXGE is .OtX)S of ehc con�ract price ixnder $],00(?,000 or E.50 - w}iic�ever'iB -
<br /> g:eatcr. For valuatfons over Si,000A00 call che �epartment of Inspectional Scrvices for the price. '
<br /> The undersi�neri hereby appS�es to the City for issuance of a Niechazrical Pet�nzt, agrees co �o '-
<br /> a1I work in stricf accorda�leE with the ardizianc:es c�f�t�r. ('xty and the regulacions o�che Minnesota '. _ :;>;
<br /> State Buildi,mg Code, and cenifies that ali statemcnts made on this application are complete, tcue - �
<br /> and correct. ; ' �.
<br /> APFIicauf's Sigziaturc: , , ''7' .�. � Dace: �,. ��� � - ;;
<br /> ;
<br /> �.d.s,�: �� .._�._ ..
<br /> � Appxoved By: Dafe: ; ;y.
<br />
|