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02iO3�93 ,, i1t52 TF� CITY OF OROtJD 612-473-?357 003 ; <br /> r � <br /> . waop BL�N�vc $av�� , <br /> � Woad atove wtth flue • � <br /> Wood combinatlon or add-on _ _ � <br /> � Factoty iixepiace wIU� fluc �� � : � � " <br /> Aactory Flrcplacc (�) ^_____ Prceatanding Meaonry : <br /> � Wood;Stove .(s) � __ � l�rankltn, othcr � <br /> �-t�jC�U�LIIsS ModelNo. 3 F <br /> Brend Name���7�.��(N — ---y--x---- � — <br /> I14fgr's Mln.. Cleerancea, aide O'' , rtar_O", min. fluc dle. �5-O�. � �-S� <br /> . _ � __.— . Total_ <br /> �NTII.ATION <br /> No. Kttchen �achaust ducted ___�,_ rcclrculal��g cf�ii <br /> No.. D�+th Lxhnust (mu�t be ducccd ou��idc) cfm cfm <br /> No. Other Fans: Locations , _.-- <br /> To191 <br /> FUEL ST�RAGE (MUST BE APPROVED HY FIRB MARSNAL) <br /> Installation _ Removal , <br /> Fuel oll; gallons undcrground lnslde outsl�e <br /> _____- <br /> LP C3as� _ gatluns C�as opettJng <br /> Other �. — <br /> PERMIT FEE CAL.CULATrOI� �(� �;e' 3C,� <br /> � 1. 1.2596 oE rOntcsCt PdC�� 0[ Mlnimum Fee [S3 .00I � � <br /> 2. $�ate Surcher¢e. ** Add thc State Hullding Code Division S •�( �- <br /> ' ' Surchnr�e to eaeh permlt. <br /> �. �i�UftG (Orily mail-in appilcatlons) � <br /> an <br />�:t:; <br /> 4. TOTAL PERMI'f.pBB (Add Ilne� 1-3 above) S S, � — <br />�;;�, ;. . <br />�''r. * CI�NTRACT PRICB o[JOH COST medns lhe Rctu�l o[etlim�ted dollar amount chud�d for thc perTnlllal <br /> ��; <br />;s;�:; work lncluding nwe�lv�� l�bor� protlt� �nd othe� fU�ed oo��t� 1t It the unvunt to be ch�rged �o �hn <br />'3f�: cuatomer foc the worlc�dono. lf tny m�teNv� equlpmeut, l�bor�or ln�t�Utivn ue NcnlsDed by�a own�r, <br /> }; tenant or�ny othac puty the rwson�bie muket vtlue of sucL lteuv must be �ddeA to the es�lrunted cosc <br />•�- <br /> or contr�ct prta for pecmlt fee purposa. In the event th�t thece I��dispu�e on the unount ot ihc)o cos�, <br />�=' .� the City ms►y tequest the �ubml��loa o[a �Igned oopy o(the tctu�l contrect. <br /> •• 'ibe STA'tE SURCHARC3B ls .0003 of the contr�et pdco under 51.000.000 or 5.30 • whichcvcr Is <br /> grceter. For v�lu�llon� over 51,000,000 ea1� the Deptrtment of inspoction�l Servicx� for the prlce. <br /> The undersigned hereby,appUea to lhe Clty tt�r i��uunc:c uf a MeeUaiilcal Pern�lt� agcees to do <br /> ail work in strict accordance wtth the ordtnaaces of thc Ctty and thc regulations o[chc Mlnncsoca <br /> � � State Building Code� and certittes that all atatemenu mado on this appticaclon are complcte, truc <br />.t.:;: and correct. <br /> r; • <br /> �� t. bate: J �8 7� <br /> AppllcAnt'e Signatur�: <br />