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.. <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 /> VENTILATION <br /> No. Kitchen E�chaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfin <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 /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> 3SDo °tl x .0125 $ �3. �S <br /> (contract price) <br /> 2. State SurcharQe. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ �, 7� <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handling (Only mail-in applications) $ 1.50 _ <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 7� � <br /> * CONTRACT ?'RICE cr T^B COST mea.�s the actual or esLimated dolla: amount charged for the permitted <br /> work includin�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 fumished 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 /> ;' l <br /> Applicant's Signature: ��,���� ���, Date: �Z�/l D Z-- <br /> A�rove Bv• Date: <br /> �{ck. �(i� c-��i �7`i FI i „ „ + „ „ _ „ — ■ i �I i <br />