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,���- - �., . . . <br /> , . , _ � .. : , ,. ; � - <br /> :� <br /> ;� , <br /> ;� . <br /> FIREPLACES <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 /> ::y: <br />�'W <br />�i�-: <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. OthPr Fa�is: Locati�ns 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 />��; <br /> Other Gas opening <br />�_;:�: <br />��` PERMIT FEE CALCULATION <br /> � 1. 1.25% of Contract Price* or Minimum Fee ($35.00) —� <br /> � -; <br />�: -: `j �_ �,: ' - x .0125 $ ��, . �`� <br />�' (contract price) <br />� 2. State Surcharge. ** Add the State Building Code Division <br />�x Surcharge to each permit. �� ;f ('.(` � ` - x .0005 $ � , '`�� <br />�� or $.50, whichever is greater (contract price) <br />�� <br /> � 3. PostaQe and Handlin� (Only mail-in applications) $ 1.50 <br />�� 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ `j `q J `r <br />��. <br />�rt * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br />�'" work ine.uding::iaterials, laboi, p;ofit, and other fixed costs. It is the amount to be char�e�l ta tLe cust�mer <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 /> ' 'Q � �.-�� ' �/��-- Date: � - O - <br /> Applicant s 5��,,nature: ,Z �� � / O/ <br /> + - <br /> Approved By: Date: <br /> ��:=. <br /> . , <br /> �, , _, <br /> . : <br /> , , � � <br /> .. , . : <br /> , <br /> _4 .. :_. .. . , �' ..�v <br /> _ :._ _. .�. _. ° <br /> 4 a.f ' . . . .......�,... .. . . ._�._.,_....,.,.u_ . ._ ..�c.,.lcis...�..c <br />