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_ r � <br /> � . � <br /> FIREPLAC � � <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 Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <br /> � FU'EL STORAG� (MUST BE AFPROVED BY FIP.E MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> :� -- <br /> Other Gas opening <br /> a <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or nlinimum Fee ($35.00) � ,� <br /> 'i �f�",�" , C`7' x .o125 $ _ � � � � 5 <br /> ; <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division .�- / <br /> Surcharge to each permit. `�/�''� , C'7? x .0005 $ � � � � <br /> or $.50, whichever is greater (conttact price) <br /> 3. Posta�e and Handlin� (Only mail-i�a-applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ � <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 /> far the wark done. Ii any materiai, 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 $1,000,000 call the Department of Inspectional Services for the price. <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance with the ordinances of the City and the regulations of the Minnesota <br /> t: State Building Code, and certifies that all statements made on this application are complete, true <br /> and correct. <br /> � i ' ,� <br /> Applicant's Signature: % � Date: 5 '� <br /> r' Approved By: Date: <br /> �� !t 'li4 <br />$ . .. . I�, u ... Y �. t . 'f,.s�s�x <br />