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Aua-2T-2001 02:16pm From-CITY OF ORONO +9522494616 T-697 P.003/003 F-670 <br /> � � �IREPLACES <br /> � Gas factary fireplace <br /> Wood burning fa fireplace with flue <br /> Wood Stov <br /> Woo ove with flue <br /> d Name Model No. � <br /> 'VENTILATION. . <br /> No. � Ritchen Fxha _ � recirculating cfm <br /> No. ust (musE be ducted outside) cfm <br /> Ottier Fans: Location:, " �� <br /> T�'LiEi..S3'��RAtG�� (�VIUST B�APPR.OVE� BY FT�2E NiARS�311L) <br /> T�stallation " � �Removal . <br /> _ L� �el oil: I,p00 gallons �(�� underground inside X outside <br /> � T�Gas: gallons <br /> �.Other . Gas opening <br /> nL <br /> PERMIT �'EE CAY.CULAT�QN . `"� <br /> 1. 1.25� of Contract Price* or�Mi 'm—mn Fee �$35.401 �� <br /> � _ � 1�500 x .4125 $ I$, ' y <br /> �- <br /> � • . (concracc price) <br /> 2. �tate Surchar�e. ** Add the State Building Code Division <br /> Surcharge to�ach pernut. . � I,506 � x .OdOs $ ~Q.?�j <br /> or $.50, whi,chever is greater (coni�act price) j <br /> �J <br /> � � � Y PP ) ' $ 1.50 v <br /> 3. Posta e and Handlin Onl mail-in a lications ,n � <br /> 4. TOTAL PF.RNII'T FEE (Add lines 1-3 above) $ Z. _ ✓,�-� � <br /> * CONTRACT pRiC�or JOB COST means the actual or estimated dollar auiount charged for the permiucd <br /> � work includiug materials,Iabor�profit,and otber fi�ccd costs. It is the amount ta be charged w the customer <br /> for tile work douc. Ir a�ry material,cquipment,labor,or insttaYlZatiaa are fiuuished by fne owner, tenant or <br /> suy othtr party the reasonablt market value oi such items must be added to the�stunated cost or contract <br /> . price.for perznit fee purposes. In the evet�t tha�there is a dispute on the amount of the job cosc,th�City lnay <br /> request the submissiou of a sigr�ed copy of the actual contract. � � <br /> "'* The S7ATE SU�tCHARGE is.0005 of the contract price under$1,000,000 or $.SO-whichever is greater.� <br /> � For valuations over$1,000,000 call the Deparcment of Inspectional Services for the pricc. /� -;�; <br /> _ ../', c"`.% <br /> The undersigned hereby ap�lies to the Ciry for issuazlce of a Meehanical Fermi[, agrees to do alI <br /> work in strict accordanee with the ordinances of the City 2u�d the regulations of the Minnesota <br /> State Buildin� Code, and eertifies that all statements made on this application are conaplete, true <br /> and cOifCCi.� �' ���+�w,�„ <br /> � < <br /> Applicant's Signature: _— Nl1GI I�ef�G�,��I7ate: g �Z�'�� <br /> Approved By: Date: <br />