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CITY OF ORONO � 6124730510 01/16/97 11:09 � :05/05 N0:862 <br /> . <br /> .. <br /> � <br /> � � <br /> ° �'VUOD BURNtNG EUUI,�NT <br /> Wood stove with flue <br /> � Waad c�mbination or add=oi� <br /> �____ Factory fireplace with flu� <br /> �� F�►ctory Firepl�ce (a)_� Fmstariding __ Masottry <br /> Wood Stove (s) Franklin, dther <br /> Brgnd Name _ �____ Model Nc�. _ � �__ <br /> Mfgr's Min., Clearances, side��� rear_ , mi». t]ue dia. <br /> VEiVTILATIUN <br /> No. KitcheU Exhaust _ ducted recircuiating cfm <br /> No. Hath ["sxhaust (muat be ducted outside) �cfm <br /> No. ^ Other Fans: L,oeations cfm <br /> FUEL STU1t�G� (MUST �i�: �1FPROVEll BY FIRE MAKSHAi.) <br /> Installsti�n Removal <br /> �_ Fuei oil: gallons qndeTgraund insidc OutSide <br /> _..�. L.P C3as: . galtons <br /> Uther _ .. Gas apening <br /> �Z' F�l� 4�CiJ '�A 1'�UN_ <br /> 1. 1.2596 of��ntr�t Price* ar���.,L��?2 ' ^ <br /> !zo Q,Lc�-o . x .o�2s a �,�5.o 0 <br /> ceontrac� price) - <br /> 2. �tate Surchar¢�. ""' Add the State Building Ccu1e Aivision <br /> Sun:lwrge to ebch permit. �Z De �S2.co _ x .00()S $ _ . (o� <br /> or �.50. whichcver is greater (comracc price) <br /> 3, Ynsta.Qe and Han�ili� (Only mail-in applications) $ �0_ <br /> 4. TOTAL PERMIT FEE (l1�dd lines 1-3 abave) � �� �Q <br /> * CONTRACT PRlCE a]OA[;�5T nxaos 1hs aCtual or e�tlmated clollar amwint charged far the ptrmlttcd <br /> Wnrk includiag materials, lador. profit, Md other tiaod costa. tt is thc�unount to be charged to uhe <br /> cu$tomer for the work done. If pny rnaterial,oquipmenc,l�bar,or inscallaeicm are fumished by thc owner. <br /> tenant ot any other�any the ttasonable mutcct vAlue of aucA i�ems ntuat be�dded ro the e�timated a»� <br /> �t cont�aet priec for pentu�fee pu�pon�: In the event ttu�t thcre i�a dis�xtte oa d�c aawunt of the job a�st, <br /> thb Gity msy t�cyutst the aubmiieion of s dg�d copy of the �ctual ccmt�act. <br /> •+ 7'hc BTATE SURCHARGE ;4 .0005 of tbe auntract pdc� under S1,000.000 or �.Sq - whichever is <br /> graat�r. For vduationd over S1,OOO,QQO call tAe Dcputment of Inspec:tionel 5ervicee fur the pricc. <br /> 1'he undcrsigned hqteby applies to the City for is�uance of a Mechunical Permit, agrecs to do <br /> all work M stric:t accarciAncc with�dx orbinat�ces of tIx City a�i t� regulati�n� nf the Minncsota <br /> State Duilding Cak, nrx! Ifies ihat all statemertts made on this applicaeion are complete. true <br /> e►t�d correct. <br /> Applicaat's Sigtinture: Dau: ��—R 9 <br /> Ap�prvvcd Hy: �._._ Date: 4b'�' g g <br />