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CiTY OF ORONO '� 6122494616 tJ9/23/99 09:27 � :03/03 N0:877 <br /> , <br /> VVood stvve with fhu <br /> �Voud wmbi�tion or add-on <br /> Factory fireplace with ticu <br /> Factoty Fireplact (s)� .Ftr�staAding Masanry <br /> �� woaa sravc' (s) ,�: Prassklin, cx)�r _ <br /> Brand Namc Ma�! Na <br /> Mfgr'� Min.� Clcara�es.side„�,�,, roar , mm. fl�dia. <br /> VENTILAT�ON <br /> Nu. � YEitchen Exhsust duct�od recitculaung ` cfm <br /> No. �, Bath F.zhaust (must �dacted outsidc) cfm <br /> No. _,�L,,,. Otl�r Fans: na �O cfm <br /> � <br /> EI�EL.�Tfl� (NNST 8E APPRO�D H7t MARSHAl..) <br /> Instaltation icemov�l <br /> Puel oil: gallo�s -_ usuierground inside attside <br /> �P E}ea: 'gullons <br /> __..r.,..� <br /> 4ther Gas oP�ninB <br /> 1. 1.2596 of�q�,ct PricG* or <br /> � x .Al2S � ��.SL� <br /> ���� <br /> Z. �tA' �, r,�� w*Adti the St$tc Building Coc�e Divisian <br /> Surcharge to �ch permit. �_ x .00OS s �'�ib _ <br /> or �:SO, wbichcwcr ii gtzater tcorw�c� prioe) <br /> 3. (Only ma�il-in s�pplications) S 1.5(? . <br /> : 4. TOTAL PF1tMIT FEE (Add li�es 1=3 abovt) S �q�� <br /> + CONTRACT PRiCE o�7Q$COST me�tbe�ctwl ot a�d dollar aswum chu�od fo:tlu pest�ued <br /> work iaclt�dias �aate�ials, ld�or, proih, t�dd�tba' tkod oaq. It is the amount to be chatged to the <br /> c�eoome�6x fbe w+ock d�e. if any nWetiu.equ�nc.laba.a it�tW�tioo�re !t}miebed by tt�e oa►ner. <br /> te�ata.ar aqy od�er�uty tlie r�mwaable.aNrl�et vatoe.ot Ndt itams m�t be�dded to the estisruucd cost <br /> or coq�act�ce.tor permit iee puipores. 1a.tbe eveut tb�tl�ar+e!�a dltpu�e a�d��mao�mt of tbe job c�et. <br /> • tbe ChY �oaY 1'e4� �aubn�aioa af a�i,p�ed oop�►oi t6e actu�! comaaGt'. <br /> «• Tbe STATE St7itCH�IRGE it ,4003 of the eoatraet prk�e unda+r 51,000,000 0: S.SQ • wt�vec u <br /> `: �reauc... �'.v�luatians over S1.O�,OOD�1! i1�e D�ent of Ia�pectionai Saveca for tho ptice. <br /> 'The �ers� hcnby applies to the City for issuance of a Mxhanical Permit, a�reea to do <br /> e21 w�rk in�ct.acxor�ance with the ord`u�aAces of d�e Cit�► a�d tbe regulationa af the 1V�innesota <br /> Statc Bui�ding Code. and c�rtifies tl�at aIl�ts tinsuie on tbis apgticadon are complete. tnie <br /> and cormt. <br /> Appiicent's Sigt�aWce: Date; <br /> ,��ey; na�e: S• 0^ 4- <br />