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. . . _..� � � �, <br /> , ... . , :, <br /> . , <br /> . . , . , <br /> � ���� � <br /> : I <br /> - - � w <br /> I , <br /> FIREPLACES <br /> ✓Cias factory fireplace <br /> Wood burning factory fireplace with flue <br /> Wood Stove <br /> Wood stove with flue <br /> Brand Name C��/>��(2_A �� �C2 C= Model No. �Fa(��j-���� <br /> ` r--1 <br /> �' `�c L-�c--� . J Ack��o� X X L <br /> VENTILATION <br /> No. Kitchen Exhaust 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 /> i <br /> ; PERMIT FEE CALCULATION <br /> i 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> � �i`��-4 CU . �� x .0125 $ (9 a .�� <br /> # (contract price) <br /> ; 2. State Surcharge. ** Add the State Building Code Division <br /> ' Surcharge to each permit. x .0005 $ � � �-� <br /> � or $.50, whichever is greater (contract price) <br /> 3. Postage and Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �3. p p <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 /> ** 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 /> , � <br /> � <br /> i" <br /> Applicant's Signature: � Date: lb -, 5 • ��-�-�- <br /> Approved By: '�� Date: � <br /> � , �; } <br /> ... ,_ .. _ , . . . .�:.. .i,-, _ . _�=- u . _ .. . .._ _ . . , ... __--�__ ,_ . ,_� ...__ LL.r.� .a.�,..._.� _ . ,.._�._._ . .. <br />