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<br /> ' �ITY OF ORONO � 6124730510 03/28/9b 09:39 � °03/03 N0:972
<br /> � ,�,-
<br /> � .
<br /> s� 7 9z7
<br /> woo B�u���av���;NT
<br /> Wood stove with flue
<br /> � Wood con�bination or add-c�n
<br /> � �'acto�`y �epi�sG� with flue
<br /> Factory �'ire�lace (s} � Preestanding 11�asor�zy
<br /> Wood Stave (s) � �ranklin, other �
<br /> Br�nd Name Model No. �
<br /> �M��r's Min., Clcarances, sic�e , re�r , mi�, f�u� dia. _ �
<br /> VENTI.LA�'jQH
<br /> �c�. �� Kitehen �xhaust / c3ucted recirculatin� 5'e�c, cfni
<br /> No. �� ��th F,xhau�t (mvst bE ducted outside) � cfm
<br /> Na. Other Fans: ?..ocations . - — ___ � +�fm
<br /> �'U�Y.�.S"�"OR.AC'�;F (.MUST BI: APPRdVED DY FTRE MAKSH�AL)
<br /> Xn���llatic�� �.emovai
<br /> ��el oil:��� g�llons underground ��,� insi�le auts�de
<br /> � LP Gas: . --- gallc�ns �.
<br /> � Other .,,,_„ <� Gas opcning
<br /> � _� �,
<br /> �'�RNI'Y�'_��+"�C�►�T�r:�TY�
<br /> 1. i.25% �f �i trac�,�e'" or M�lr im,�m �+'ee��Q,4�
<br /> -� 7 �� � x .0125 $ ___�_�.`f�`..�____�_
<br /> ^� �
<br /> tract price}
<br /> �; ;St�re Sr�rchar��,, '�* Add the State �3uii�iin$ Code bivision
<br /> S�irct�ar�e to e�eh perrnit. ��- ��'`j/ ��, x .OQOS $ //�y L
<br /> or $.54, which�v�:r is greater {cancra�c price)
<br /> 3.. �,����,�,�, (C�nly tnail-in ap�lications} $ ^�.1 5�.._.
<br /> �,. TUTAI. Y�RMIT ��� (��id lin�s 1-3 �bov�� $ ��--.--
<br /> * CONTRAt�'1' P�t10E qr JOI�CdST meuns che a�:tual s�r estitnuted �ollar arn�unt chargcd for tho�crmitteci
<br /> work including n�s.t�rials, labnr, pro�t, ��d othe; t�xtc! coscs. It is thc a�otint ta he cha,•�ed to th�
<br /> C1L9Tn�EC fQC[�}C WOCk��UC. if any rnaterial, eqi►i�ment, ln�r, or inst�llat.ion are furnished b�th.e own�r,
<br /> tenant c�r any ocl�r;r }�any tlia reusonabl� .market value of such items r►aust t>e addQd ta che xstimated cest
<br /> or�onuacC price far F�rrr�it fee purpo�. In thc evenc shat thore is u dispute c�n thc atnouat of the job cost,
<br /> the �ity rtaay request the s�tbtnissinn nf� si�,�ed copy of ttae actnal contract.
<br /> w+ The.5l'AT� SU�tC��ARG� is ..UQ()5 of the c,�ntrwc:t price undcr $1,00(1.0t� or 5.50 - whicl�ever is
<br /> �reaser. �'nr va�uations over S�,O4o,4UQ ca1! tfie Dcpaxtment of 1�sp�Ciirsn�4 Servic�s for tha price,
<br /> The .utldersi�ned hereby app.aies tp Che City f�r it��suancc of a Mechanical Petrnit, agr�as to dr�
<br /> all work in.strict acca.rdance witt� the ordirtances c�f the Ciry and the reg�ulations of the Minn�s��a
<br /> StEit� Bµildin� Ccxie, and cerci�ies ttiat all statemeuts madc on this apjalic�tion are enmplete, true
<br /> ��d cor�ec:t. ---�
<br /> ��: ,,��� Date: A
<br /> APpiicanc's�i�nuture: . _�.
<br /> . Ap�rav�d Ry: \ � ._..�,...�..,., - Date: �}' � a
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