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t � s <br /> f <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF -2002 STATE STATUE <br /> ❑ Yes,this section applies <br /> The replacement of a Residentiai fixture or appliance that meets 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;excludins the cost of the fixture or applisnce:and <br /> 3. Is improved,installed or replaced by the homeowner or licensed contractor. <br /> Skip next�ction,if this applies; Cost of Pertnit $ 15.00 <br /> State Surcharge $ .50 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> PERMIT FEE CALCULATION S —JOBS OVER$500.00 <br /> If above does not apply;follow guidelines below: <br /> 1. CONTRACT PRICE *is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> �.1 LC.� _ x A125$ '�`-' L� - <br /> (contract price) (minimu 550.00) ; <br /> � �--/ <br /> 2. STATE SURCAARGE *•Add the State Bldg Code Div. Surcharge(Minimum Fee of 5.50) <br /> �f`�. X.000s s 1 . �;�� <br /> (contract price) (minimum S .SO) <br /> 3. POSTAGE&HANDLING(Only on Mail-In Applications) $ 2.00 <br /> �r- � <br /> 4. TOTAL PERNIIT FEE(Add Lines 1-3 Above) $ , t` �' �� <br /> • ' CONTRACT PRICE or JOB COST meens the actual or estimated dollar amount charged for the <br /> permitted work including materials,labor,profit,and other fixed costs. It is the amount to be charged <br /> to the customer for the work done. If any material, equipment, labor or installations are furnished by <br /> the owner,tenant or any other party,the reasonable market value of such items must be added to the <br /> estimated cost or contract price for petmit fee ptu�poses. In the event that there is a dispute on the <br /> amount of the job cost,the City may request the submission of a signed copy of the actual contract. <br /> ■ •'The STATE SURCHARGE is.0005 of the Building Depazhnent at(952)249-4600 for the price. <br /> MECHANICAL PERMIT APPLICATION AGREEMENT <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the State of <br /> Minnesota, and certif`ies that all statements made on this application are complete, true and <br /> correct. <br /> +. <br /> / �` �/ 7 �� <br /> A licant's Si nature: . � /� , /��j/ ��_" Date: �'1 l � � <br /> PP g <br /> Reset Form <br /> 3 <br />