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09l03l2015 15:27 Riccar Heating �AX}763 754 0132 P.004l004 <br /> pERMIT FLE CALCULATiQN(S) <br /> BASED OPF -2002 STAT�STA,'�LTE <br /> ❑ �Cas,this soction applies <br /> Thc replacement of a Re$idential fixture or snnliance that meets all threo of tha follvwing requirements: <br /> I. Does not require modification to electrical or gns service. <br /> 2. Has a t tQ al cost of$500.00 or less;�the cost of the fixture or appliance:and <br /> 3. Is imprvvad,�nstalled or replaced by the homeowner or licensed contractor. <br /> Skip next section,if this applies; Cost of Permit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-Tn Fee(If Applicable) $ 2.00 <br /> Total Permit Fee $ <br /> �ERIvIIT FEL CALC'CIL�ITION S -JOBS OV�R$500.00 <br /> If above does nac apply;follow guidelines below: <br /> 1. �IYTRACT PRICE *is 1.25%of con�act prace with a(Minlmum Fee of$50.D0) <br /> �6 .� X.oi2s$ �G <br /> contfRct pflCe) (minlmum$50,00) <br /> 2. �TATT�SURCI-YAYtGE <br /> x.0005 $ �• �� <br /> (wnuact price) <br /> 3. PQSTAGE&HANDLIN(3(Only on Mail�In Applications) $ <br /> 4. TOTAL PERMIT FEE(qdd Lines 1-3 Above) $ r(� � � <br /> � * CONTRACT PRICE or JOB COST means the actual or estimarad dollar amount charged for the <br /> permitted work including materials, labor, profit, and other fixod costs. It is the amount to be charged <br /> to the customer for the work done. If sny material,equipment, labor or installetions are furnished by <br /> the ownar, tenant or any other p�rty,the ressonable market vaiue of such items must be sdded io the <br /> ostimated cost or contract price for permit fee purposes. In the er+ent that there is a dispute on the <br /> amount af the job cost, the City may request the submission of a slgned copy of the actual contract. <br /> iviECI�'ANTGA.�,�ERMT'I'ApPLYCATION AGREEMENT <br /> The undersigned hereby applies to the City for issuance of a Mechanical PeiTnit, agrees to do all <br /> work in strict accordance with the� ordinances of the City and the regulations of tho State of <br /> Minttesota, and certifies that all statements made on this applieation are complete, true and <br /> correct. <br /> Applicant's Signature: G¢.Q( V pate: g r ��-/ � <br /> 3 <br />