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:a�-13�•2J04 02:2�.R Fronr,t'`' OF OP,ONG <br /> +99224od6;6 T-642 P )03/003 F-60? <br /> YER1�'r_�'�;E CALCL�'I..A'I'ION(� <br /> 0 2 State r e � �'es, This Sectian Applies <br /> The replacement of a Resident' �xture ar a�pl� nce that tz�eets all three of tY:e foilowing <br /> requ iremtnts� <br /> 1 j _ ��es not require modificatinn to electrical or gas service. <br /> 2) Has a t t• cos of 5500.00 or less; e�lud�g the cosc of rhe fixcure or appliance: <br /> and , <br /> 3> Ys improved, installed or rcplaced by the homeo�.�n�r or liceru:ed contractor. <br /> Skip next sectio�; Cost of Permit � ._ _ _15.00 <br /> Stau Svrcharge $ .50 <br /> Mai3 In 1 ee $ _____ 1 j 0 <br /> If above does n�t �pply, follow guidelines below: <br /> 1. Contra��Priee* i.s .0125 °l of job with a :1�iinimum Fee of �.00 <br /> — �-�-���� x .012 S $ ._ ! `l3, l�-- <br /> (concrac; pricc) (rninimum S35.UU) <br /> ... State Surcharge, �`* Add thc State Building Code Division a (Minimwn Fee of$ .501 <br /> —=-�--�.1.� �� x .0045 � _ _ � 7 ..r.- <br /> (cenrracc pricc) �minimum $ .SG) <br /> 3. PostaQe and Hanc�ling �Only mail-in applicatiar.$) $ „� 1 50 <br /> 4. T01'AT. �'ER'�1IT FEE (Add lines 1•3 above) S d O � `�� <br /> • CUN7RACT PR.ICE or JOB COST means t};t actual or ascimated do.la��amounc charved fnr die permitted <br /> v��ork including rr,aceria;s, labor,profit, tr:d other Gxed costs. It is[he amount to bc charged to the cus:ome: <br /> for che u�ork dune, (f any ma:rr;al, equipmzr.t, lab�r, or ins�aUacion ate furnished by ehe owntr, trnant or <br /> ��y ochcr parry che rensonable markec va]ue of such items must be added co the es�imeted cosr or conaact <br /> pr�ce for peiniu tee purposes. In rh�evenc cha�el:ere is a dispute on thc arnount of:he job cost, t,`�r;Ciry r.i3y <br /> r�quut tl�e submission of a sigiied cop�of�re actual contcaet. <br /> +` '1'he STATE SL'RCH�RGE is .0005 of�T:e contract price utder 31.000,000 or �.50 - whichevc�r is grea�ec. <br /> For va]uarions over$1,OOO,C00 call the Depa�rmcnt of Inspect;cn 3er;ices frn chc price. <br /> The urulersigned hereby applies to thc City for issuance of a Plumbing Permit, a,grees to do a11 <br /> work in scrict accordance with the ordinanees of tht City and the reguiations of the State of <br /> Minnesota, and certifies that all staterr, n�s e on � app;ication are complete, true and <br /> correct. � <br /> Applicant's Signaturc: I?ace: <br />