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__ T . _.T�-,�_ . �.�. _ <br /> ; ; . . . <br /> . <br /> � , , . <br />� �. <br /> .. <br /> , � _ . . <br /> . �� a <br /> FIREPLACES <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 /> ,�; <br />;r;- - <br /> � ; VENTILATION � <br /> y�.:, No. i Kitchen Exhaust .aC ducted recirculating � cfm ? �� <br />�, No. Bath E�chaust (must be ducted outside) �,�QJ cfm � <br /> No. Other Fans: Locations cfm :� <br /><�, ��� �R�i'1:�e�9�2 cx�hr.,�c ��-,� vPn,rv►u,r-��/oa.0 �Ci� G/�� � <br />� FUEL STORAGE (MUST BE APPROV�D BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside a'. <br />- LP Gas: gallons <br />`"�° Other Gas opening '"" <br /> 4i J <br />�R. <br />.� � <br />,�;' PERMIT FEE CALCULATION <br />�'�i l. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> 3� �3/ x .0125 $ y/�/, / 3 <br />:l: (contract price) ,; <br /> 2. State Surchar�e. ** Add the State Building Code Division '" <br /> , S <br />�,j Surcharge to each permit. x .0005 $ ;6, s� <br /> or $.50, whichever is greater (contract price) ��� <br />;�r <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 ; <br /> ;�<• 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ y��. '� <br /> �, <br />�� <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 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 <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 /> <�' <br />�;_. . <br /> ** The STATE SURCHARGE is .0005 of the contract price under�1,000,000 or $.50 - whichever is greater. <br />_,;: <br /> For valuations over $1,000,000 call the Department of Inspectional Services for the price. <br /> ��f The undersigned hereby applies to the City 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 thi pplication are complete, true <br /> and correct. ; <br /> �'; <br /> '� Applicant's Signature: Date: //- ��� <br /> }'` Approved By: Date: <br /> � � <br /> - � _ , Y � <br /> p <br />