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� � <br /> .t; :�. ^ �F �"a . `,. . g"+ `°�"f$a py.,:� ���. r a;, . .+� 3� r' '�t� <br />�. �:�. ,�.. .:�; ...,.:,. . ...�:.�:. _ ..:..; r.;+f. {., .�.�.b ..,,, . ... �'��' ._ . . . �. . . . . .,�.�. ��.�*6.�_�#�'��. .ti't ,.,a�t�`�;�c.. :'��, <br /> FIREPLA ES <br /> Gas factory fireplace <br /> Wood burning factory fireplace with flue � <br /> Wood Stove <br /> Wood stove with flue <br /> ,; �. <br /> Brand Name � " � 4 � � Model No. � Ir� � � � � <br /> VENTILATION <br /> No. Kitchen E�aust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <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 /> � <br /> PERI�TIT FEE CALCULATION � � <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) � ��j� <br /> =�`�c�c�' ` ` x .0125 $ �� , <<�. <br /> (contract price) � <br /> 2. State Surcharge. ** Add the State Building Code Division � �p <br /> c4�. <br /> Surcharge to each permit. ��J�:�� -— �?�:0003� �`�$ �. �C.� <br /> or $.50, whichever is greater (contract price) �'����' ' ' <br /> Itkrt� ; .,, <br /> ,�����,�:�.�.��►�� � �° <br /> 3. Postage and Handling (Only mail-in applicatib�f� �'����"�'� �$ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) �"`'��`" ` �$ �, �7�'' "f � � 7 D <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 /> a <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 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 /> r <br /> Applicant's Signature: ?�(.,�u.��� ;' Date: � <br /> Approved By: Date: <br />