|
11/08/2009 07:16 9529222434 SAYLER HVAC PAGE 04/04
<br /> �.�,.��,.,.,,����::;:.....�.. _
<br /> �,.,..,,�,,;, ���;�,,,� ��f,�,��,,;::.,,:,,,��..,,, ,. ,�.,,,,,, ,d�,
<br /> ,�,,,,� ,. ,.,u, ,.
<br /> ;.;.',11..�`.�:1.".:�: � :.:.... ,'�1' ,1,1 V_;_II . . .. ....�... .1. � ,....:'„'v. �:'):'i;i;i:i::: ' �;:.�� -:�,.�,
<br /> ��
<br /> �ilu��Y?q,�,....,� .�.. �i�.�!}r.:c._. ''� ,t�{ i d`' �:i.: ..,ill�tc�� :.i..�.�.
<br /> �� [� s
<br /> �
<br /> ��i�... ,/�,..'
<br /> .i.n��..:......_i. ....._�. .......,_...:b,.....:-e:r.::��.�� . . ._ _ _ - "-_ "
<br /> ..r.: .�...__.......���.�..:.............��.�..............1..� . .. ..7r_i ' '�."Cr ,f�.l�C1'c��Q�.
<br /> .........�....,..__:.. f1._.-.._.... �i ���� i,� ... �i
<br /> � .... � ;..
<br /> . . (
<br /> �..�..,.�� : 1111t �. �������4���I i, ....� �i I�l 911 � � ��.,�•111'. Ti�nli�i.� �. -.��:.�'.,:i.i� �il'� )
<br /> ���,�I�., ���e q��1� �1 In I,d�Uq, �i q� � �i Imi „) .a e�� �.,L.1.I�\.���!)�IPI '�1��; '�!P.�W,i'c�'t" �'.r`6 j'j"j'
<br /> ���::��llulr�. :.II:��Nf�l��_�IiII�IN�M.i.J.l.11�����ll_.1.�:���(1.1 1 ��� �i• t �. . .. �: .I�,i,iqi�: ..I:��i��
<br /> : :� ...�....
<br /> . ._........
<br /> i { �11.':I.. .��C!��li��i�....
<br /> :..�..� ....,'_._..���-.�. ....�.�........_._....� . . .'. A .� _ _A �r�4 ��I'�I:�� _
<br /> i �'
<br /> �'
<br /> ........_...i..��..�- I . Cf..t_:::.�.:: � .. :J T . _ ...... .
<br /> ..... .......�....... ' � - - _
<br /> �.�,.......... , i . � _:,.M:�� f f. _ ��j::._._::_':i, :::I:I
<br /> . ........_........�..�..a.,.�,.�..,.........s.�. •}J r . � ' ,���F�![��V'�`' ;ii6 5��i�n..
<br /> :.��i jli5;liiei�:
<br /> � Yes,this section applics
<br /> The re�tacement of a Reside,�tial fxture or appliance cbat meets alt threc of the following rec�uirements:
<br /> 1. Does not require modification to elech-ice�or gas service.
<br /> 2. H�a t (cost of$500_00 or less;excludin¢the cost of the f�tu�'e or appliance:and
<br /> 3. Is improved,installed or replaeed by the homeowner or lieensed contractor.
<br /> Skip next section,[�ct►is applies; Cost of�erraait $ i 5.00
<br /> Statc 5urcharge $ 5.00
<br /> Mail-In Fee(IfApplicable) $ 2.00
<br /> �'otal Permit Fee $
<br /> ::.:. .......
<br /> ._._.........:::_.:,..::.:.:....._......
<br /> ,..,..._._........--......_........ � -=
<br /> . „ .,.:.... ...
<br /> _...
<br /> -,..e��mr � ..,.:�� i � ..,. . .,.
<br /> .
<br /> . .. ..
<br /> :,:�,,,.,,�,. � , ,.�„ �..,y , .; f � . � : ..., :.�,;,...
<br /> :. ::.,. ,�.,
<br /> .
<br /> , ,. , , . !,� c
<br /> ..
<br /> wTi �i�,��'i�t�C��'Q,Q'....I�sS
<br /> , ..P4rs?l�i�il...�1.!i{,c�. _.',. '� � 1 ' �„� �,+ '�i . ..��IiI�A� '. ! ,G:-Ji ! 1'rl��;i >er,�l'„5;�,:� .?F:
<br /> �� . .
<br /> , i � �. .��;:
<br /> lf above does not apply;follow guideli�es below'
<br /> I. CONTRACT PRiCE *is].25%ofcontract price with a(Mi�i�+um�'ee of$50.00)
<br /> lZ�Oop x.0125$ lSD
<br /> (contract pricc) {minimum 550.0�
<br /> 2. STATE SURCHARGE
<br /> ���a�v x.0005 $ �
<br /> (cantrect price)
<br /> 3_ POSTAGE&EiA,N17�,ING(Only on Mail-In�lpplicarions) $ 2_00
<br /> 4. TOTA,[.PERMiT FE�(Add Lines 1-3 Above) S l$`B�qd
<br /> • * CQNTR,ACT PRICE or JO� COST mcans thc acmal o�'estimated dollaz aznount charged for the
<br /> permitted wock iqcluding materials,labor,profit,and other fixed costs. It is the atttount to be eharged
<br /> to the customer fo�'the work donc. If any material,equipmcnt, fabor o�installations are furnished by
<br /> tl�e owner,tenant or aqy other pe�rty,thc rcasonable market value of such itcros must be added to the
<br /> estimated cost or contract price for permit fet purpases. In the ever�t that there is a dispute on the
<br /> amount of the job cosc, the City mAy request the submission of a signed copy of the actual contract.
<br /> ,::��:,.:�...:....... ...
<br /> , ,:..,....��.,, .,., _
<br /> , ..
<br /> _........_......._._.... ..::.:::::::.� - .. _
<br /> .
<br /> ---,,:::�._:�.:.- - , _....
<br /> :::::.......•:..., , , - '-•;:,;' °- _;,�• y� _ ;;:;,;:,:;-.mr-'', .,,,;;
<br /> , ,:;,�:'';'�' .,;,;; c'r, ,: ,:`,..'.., .,, ,�-T
<br /> �'1.oiC;;•1'11. ... . a � '�.. .:�' i,,'i: �.:iT ..7G:Y �;i.,i�°�..�,:.�;����,�.�.
<br /> • �. �.. .ia : ... �. : :n _
<br /> . ,i .... .. �• .
<br /> ",c
<br /> � � f ''"i'll" ,r .�L
<br /> .
<br /> F� ' '.!'`!��'.� � ' ' ,...' �""�
<br /> The u�dersigned hereby applies to the City �or issuan,ce of a MechanicaJ Pc�mit, agrees to do all
<br /> work in strict aceordance with the ordinances of tbe City and the regulatio�s of the State of
<br /> Minnesota, and certi�es that all statements made on this application are eomplete, txue and
<br /> cor�ect.
<br /> Applicant's Signature: (/ Date: `�"3a-��
<br /> 3
<br />
|