|
� . , �,� � -� -�' � � � ;-��-- �
<br /> �.��-: ` ,, , �; - � �� � �
<br /> ��� � ��'.��> 4 x �r','�y�� .�ti :. ,3 � y�'� � w � �
<br /> �`"'$J �`4 S �. ��55�t�4 � �
<br /> � Y �
<br /> � �b �" � � � y� 7 - �
<br /> � hh ?,�,RQ±� . ..s �} .. .. ... . .. . .-. .���.:. _
<br /> �' �?� ��
<br /> . �- � �� �r ���
<br /> :: +s "as ` ����r�.
<br /> 4 FIREPLACES � Y� �-����x�� ' _�
<br /> Gas factory fireplace � � �s � ,�
<br /> w��:� _
<br /> Wood burning factory fireplace with flue ��t� y � ��� �� �>;fr r t��=n
<br /> Wood Stove - �';��� `���
<br /> �� f a���' � �ye �� �,.
<br /> Wood stove with flue -
<br /> Brand Name Model No. .�
<br /> :�
<br /> VENTILATION
<br /> No. t Kitchen Exhaust � ducted recirculating cfm
<br /> No. Bath Exhaust (must be ducted outside) cfm
<br /> No. � Other Fans: Locations �-1-G�� �<.t��kan l�U cfm
<br /> V�n�ar I+RV �t,xc.l�a+��,r-� �
<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 /> PERNIIT FEE CALCULATION
<br /> 1. 1.25% of Contract Price�` or Minimum Fee ($35.00)
<br /> x .0125 $ ��; Z�a �
<br />�, (contract price) � �
<br /> 2. State Surchar�e. ** Add the State Building Code Division �
<br /> Surcharge to each permit. x .0005 $ -
<br /> 4C�
<br /> or $.50, whichever is greater (contract price)
<br /> 3. Posta�e and Handlin� (Only mail-in 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 /> 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 Ciry 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 $1,000,000 call the Department of Inspectional Services for the price. �
<br /> �
<br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all �
<br /> work in strict accordance with the ordinances of the City and the regulations of the Minnesota �
<br /> State Building Code, and certifies that all statements made on this application are complete, true
<br /> �
<br /> and correct. �
<br /> �
<br /> 2-Z.�--� Z �
<br /> Applicant's Signature: ('I�UYI�. . Date: �
<br /> Approved By: Date: ��
<br /> �
<br /> ;s
<br /> r
<br /> � ��, .��w , � � - �
<br /> �.* � �, v �, � � 3 ��a
<br /> i z� � �+�;z,_ �`»�a�°.a ,a��.�v���.,....�-i�,$_.ni� ; ,. .� .w�,.z��,,.. _,.., „.a_.� ..�r.,... _-,. w_�i..•�....��.., ..
<br />
|