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„� �'� ' � . . �''� �i a T�. ..� �. . . ., ! <br />' �i..> S ��� �R� <br /> ¢': <br /> i � <br /> 3 <br /> �y � r� <br /> U; FIREPLACES � <br /> ��.;: Gas factory fireplace <br />� r s Wood burning factory fireplace with flue <br /> Wood Stove <br /> Wood stove with flue <br /> Brand Name Model No. <br /> :, <br /> A <br /> > ;�� VENTILATION x� <br /> `' No. Kitchen Exhaust ducted recirculating cfm � <br />���fl No. Bath Exhaust (must be ducted outside) cfm <br /> y �, <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 /> s�� LP Gas: gallons <br />�� <br /> Other Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* ar i�linimum Fee ($3�-.00) ' <br /> 7� � � ,�y <br /> � JI�J> �'� x .0125 $ �,"� , <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division `� <br /> Surcharge to each permit. x .0005 $ r 3�� <br /> or $.50, whichever is greater (concract price) <br />����� 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br />�: <br /> � 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ J 1� �%_ <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 thz tivo:k done. If any material, equipment, labor, or installation are furnished by the owner, tetiant 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 />�t ` and correct. h - . <br />��;� - � f7J � <br />-- �� licant's Si nature: r � � Date: I�� 1 C_ <br /> APP g <br />�v�` _ <br /> Approved By: Date: <br /> , <br /> . <br /> � � ., � <br /> . . <br /> , ;. <br /> �. � .. � � <br /> ., ,: <br /> „ �.. .y . . v.�.:,. _ .. �.: .. �.:,� ..0 __ _ � � _ .,... . �. _ _u����.�_,.a_, , <br /> _.. _ � <br />