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.�� <br /> � <br /> FIREPLACES <br /> Gas factory fireplace <br /> Wood burning factory fireplace with flue <br /> Wood Stove <br /> Wood stove with flue <br /> ,� <br /> Brand Name Model No. <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Elchaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfin <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside fi' <br /> LP Gas: gallons � ' <br /> Other Gas opening '' <br /> `.�r <br /> PERVIIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) _ � <br />�'h, 'I�'i:` .C�-� X .oi2s � 3�.��' <br /> (contract price) <br />� 2. State Surchar�e. ** Add the State Building Code Division <br />, Surcharge to each permit. �� �u C 0 x .0005 $ �5� <br />�' or $.50, whichever is greater (contract price) <br /> 3. Postaae and Handlin� (Only mail-in applications) $ 1.50 � <br /> , <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ���-C'� <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the customer <br /> for the work�one. If any material, e�Uipment, labor, or insta;latic:�are furnisr.ed by the owner, Cenant 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 contract. <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 Ciry for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the Minnesota <br /> State Building Code, and certifies that all statements made on this application are complete, true <br /> and correct. <br /> ; � �C�� Date: I I— ZZ � <br /> _ <br /> Applicant's Signature: <br /> �. <br /> Approved By: Date: <br /> ; � , . <br />