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� • <br /> 'Apf-24`2001 10:51am From-CITY OF ORONO +9522494616 T-923 P 002/002 F-590 <br /> FT�P�,ACES <br /> Gas faccory fireplaGe <br /> 'Wood burning factory fireplace With flu� � , <br /> Waod Scove , <br /> Wood stove with flue <br /> Brand Name Model Na. , <br /> VENT'T �4TION <br /> No, T�itchen Eahaust ducted recirculatxng cfm <br /> • Iy'Q. Ba�h �xbausc (must be ducted outside) cfm ' <br /> N`o. Ocher Faras: Locations cfin <br /> FUEL S`�2�GE (MUS'� BE A�'PROVED BY F�RE MARSHAL) , <br /> XnsGaliacior� Removal <br /> '�'uel oi�: gallans und�rground �; i�side outside <br /> �LP Gas: gallons <br /> Qrher Cras opening <br /> PERIY�_ EE�CA�CULATTON" � <br /> 1: 1.25% of Contrac �rice* or Minimum �ee (�35A0) <br /> o?T„!DO. _C� � x .Q]25 $ �� �,DO <br /> (ca�cract price) <br /> 2, Stat� S� ar��. *�` Add �.he Stat.e Building Code I�ivision <br /> Surcharge r�a each permit: x .0005 � �. �� . �� <br /> ar �.50; whichever i.s g[e�icr (contract price) ��� <br /> � � � � � � � .50 � ` � � <br /> �, �stag,;e��an � andling �(Only mail-in a�plications) $• 1 ����, <br /> � 4, '�QTAI,FBRMIT FE� (Add lines 1-3 above) � $ a�7•� � i <br /> f�� <br /> * COh'TRt'.CT PRIC�a:JCB CO�x n:e;t:s the ac^a�;or estimate»do!iar a.*�a�ar.t ch�»:ge.�,for tt2e ptrm.i;2ed �G <br /> work includiva macerials, labor, prafit, and ot�er fixed eos�s. It is the amounc to be charg�d Co the customsr <br /> for the wor�C doae. If any,.ma[erial, equipment, labor, ox inscallat'son are furAl3h�d by.the owner, terizt�i ar <br /> any o[her.party che reasonabie market value of such iterns mu9t be added,to [he estimated cost or contracc <br /> price fAr permit fe�purposes, In the even[thac there is a dispµ[e ou fh�amouni of che j�b casx, [he Ciry may . <br /> requesi cha submission of a sigaed eopy of che acnial conuact. <br /> '�� The STAT�SURCHARGE is .OQOS of th�CAntra�i price undec�1,DOQ,000 or �.50, whiCher��r is greater. <br /> �'or valu�tians over$1,OQQ,Q04 call the Departcaeat of Tnspectianal SE�'vices For the price. <br /> '�'he undersig��e� hereby app�ies �� �i:c C;�y i�;� ���uanee of a Mecr.anical PLrmit, agx��s to do a11 <br /> work in strict accordance wiih ih� o�d�nances of che City and th� regulacions of the Minnesota <br /> State auilding Code, and cer�ifies that all scatemenxs made on this ap�lieation are compl�te, true <br /> � �and corre�t. � � �� � ��� � <br /> Applicant's Signature: Date: �f <br /> Approved By: DaXe; <br />