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F��o�m:�l1NTRYSIDE HEATING & COOLING 763 479 2518 08/13/2012 11 :43 #571 P.003/003 <br /> PERMIT FEE CALCULATION(S) <br /> BASED OFF - 2UOZ STATE STATUE <br /> ❑ Yes,this section applies <br /> "The replaccmcnt of a Residential fixture or anDliance that meets aU 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;excludinQ the cost of the fixturc or appliancc: and <br /> 3. Is improved,insta]led or rcplaced by the homeowner or licensed contractor_ <br /> Skip next section,ifthis applies; Cost ofPermit $ 15.00 <br /> State Surcharge $ 5.00 <br /> Mail-In Fee(If Applicable) $ 2.00 <br /> Total Permit Fee S <br /> PERMIT FEE CALCULAT'ION S —JOBS OVER$500.00 <br /> If above does not apply; follow guidelines below: <br /> 1. CONTRACT PRICF: * is 1.25%of contract price with a(Minimum Fee of$50.00) <br /> 6D oD. �,o x .o�2s $ 73: o� <br /> (contract pnce) (minimum SSO.DO) <br /> 2. STATE SURCHARGE <br /> �o OD _ oo_�_x .000s $,.____._�____._.,�---------- <br /> (contract pricc)M <br /> 3. POSTAGE&HANDLING(Only on Mail-ln Applications) � 9�d <br /> 4. TOTAL PERMIT FEE(Add Lines 1-3 Above) S �g . �� <br /> • * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the <br /> permitted work including materials, labor,profit, and ocher fixed costs. It is the amount to be charged <br /> to the cuscomer for the work done. If any material, equipmen�, labor or instaltations arc furnished by <br /> the owner, tenant or any othcr party, thc reasonabie market value of such items must be added fo the <br /> cstimated cost or contract price for permit fee purposes. 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 /> MECHANICAL PERMIT APPI.iCATION AGREEMENT ' <br /> The undersigned hereby applies to the City for issuance of a Mechanica] 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 certifies that all statements made on this application are com,plete, true and <br /> correct_ <br /> Applicant's Signature: v v Date: � ��3 ' �o"— <br /> ?63 -y1g , l�D�o <br /> Reset Form <br /> 3 <br />