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- �. <br /> 7t4. "" n3 •� a -; 4 <br /> Y 'tl <br /> qe <br /> • <br /> � <br /> 4 ct, �� �" p;pV d,.. Mv; '�a' +. ;7k'TAittemx <br /> t k§int' ,.: x .'.rt*c aft <br /> FIREPLACES � ��` �'� �� ' f � ��" �ceI <br /> - Gas factory fireplace -s#'-R ; 3. r .,$."`1 rti .'` <br /> Wood burning factory fireplace with fluer *s re 'c <br /> Wood Stove f ,�h, 1: <br /> Wood stove with flue • <br /> -� <br /> Brand Name .Model No. <br /> _ T <br /> VENTILATION. - <br /> No. Kitchen Exhaust ducted recirculating cfm . <br /> No. Bath Exhaust (must be ducted outs de) cfm <br /> No. E ms: Locations U1C } ( . v 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 /> 1-7'1 <br /> , x .0125 $ !Lo2 : <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. 13,000 x .0005 $ (p . 5 0 <br /> or $.50, whichever is greater (contract price) <br /> 3. Postage and Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ )'] (� b <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 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 /> ‹4z,Applicant's Signatnre� \, j <br /> e <br /> t)ti . Date: Fj / J 0) <br /> Approved By: Date: <br />