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<br /> FIREPLACES �����
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<br /> Gas factory fireplace " ' ' t �
<br /> Wood burning factory fireplace with flue ��
<br /> y ��� Wood Stove
<br /> �`� �, Wood stove with flue '
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<br /> �f Brand Name Model No. ,`: �;
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<br />� VENTILATION
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<br /> - No. Kitchen E�aust ducted recirculating cfm
<br /> No. Bath Exhaust (must be ducted outside) cfm
<br /> No. Other Fans: Locations cfrn
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<br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) ;;
<br /> �`� Installation Removal
<br /> Fuel oil: gallons underground inside outside ;�
<br /> LP Gas: gallons
<br /> Other Gas opening
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<br /> PERMIT FEE CALCULATION � �
<br /> 1. 1.25% of Contract Price" or Minimum Fee ($3�.00) �y
<br /> - 3�_� i 5 ' `= ` x .0125 $ '--i 3
<br /> (contract price)
<br /> 2. State Surchar�e. ** Add the State Buildin� Code Division �
<br /> Surcharge to each permit. 3�� � �e� -` ` x .000� $ � , `7 C� ��
<br /> r ��� or $.50, whichever is greater (contrac�price) �
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<br /> _, ,.. 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 ri
<br /> '' ' � 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ y 7 ' �`" ���
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<br />� "� "`"�< * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted �'%�'
<br />� , work including materials, labor,nrofit: and other fiYed costs. it is the a.mou�t t�hP char¢ed r�,h,��,;�r �`�
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<br />, ' E�; for the w�ork done. If any material, equipment, labor, or installation are furnished by the owner, tenant or
<br /> any other party the reasonable market value of such items must be added to the estimated cost or contract �s�
<br />�,�.r price for permit fee purposes. In the event that there is a dispute on the amount of the job cost, the City may ,,
<br />,�_ request the submission of a signed copy of the actual contract. ,�,
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<br /> 4 ' ** The STATE SURCHARGE is .0005 of the contract price under S1,000,000 or $.50 -whichever is greater. �
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<br /> ��- For valuations over $1,000,000 call the Department of Inspectional Ser�-ices for the price.
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<br /> '� The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all '�
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<br /> work in strict accordance with the ordinances of the City and the regulations of the Minnesota ;
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<br />�� State Building Code, and cert' ies that all statement ade on this application are complete, true -
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<br /> and correct.
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<br /> Applicant's Signature: ��` _ Date: �2- �� �' `�
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<br /> Approved By: Date:
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