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- <br /> , * � <br /> � � � <br /> FIREPLACES . ,I n�, � <br /> Gas factory fireplace <br /> Wood burning factory fireplace with flue <br /> Wood Stove <br /> Wood stove with flue <br /> Brand Name Model No. <br /> VENTILATION <br /> No. � Kitchen Exhaust 1 ducted recirculating cfin <br /> No. .3 Bath Exhaust (must be ducted outside) cfin <br /> No. Other Fans: Locations �� <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 <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> �5dv � x .0125 $ <br /> (contract'price) <br /> 2. State Surcharge. ** Add the State Building.Code Division � <br /> Surcharge to each permit: � $b o �` : x .0005 : $ <br /> - , . � or $.50, whichever is greater (contracc price) � <br /> � . . . . �,.,....i•wr M�aNaiseni isr� . . . . <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 _ <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollaz amount charged for the permitted <br /> • work including materials,labor,profit,and otiier fixed costs. It is the amount ta 1ie charged to the customer <br /> for the work done. If any material, equipment;labor,or installation aze furnished by the owner, fenant or <br /> any other party the reasonable market value of such items must be added to.the estimated cost or:contract - <br /> 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 conttact. <br /> ** The STATE SURCHARGE is .0005 of the contract price under$1,000,000 or $.50-whichever is greater. <br /> � For valuations over $1,000,000 call the Department of inspectional Services for the price. <br /> � The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance witti the ordinances of the City and the regulations of the Muuiesota " <br /> �... <br /> : , <�.., <br /> " ` �"-"State�Building Code; anc�eertifies•that all statements:made on tlus application are complete, true <br /> . . (._. �...rl.,nr.r, N.•Y�T <br /> and correct. : : - �:: <br /> -� .. �3:s � '�� ��. � <br /> � � ; <br /> . .. . . . � �....�;:'e� _ v'S YY:c:�. __ ' <br /> Applicant's Signa e: '�=� ` _ . ., �Date: ' ''.�_ <br /> APProved By: Date: <br />