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i <br /> � i; <br /> , i„ <br /> �s: <br /> , <br /> '�� <br /> FIREPLACES �� <br /> � Gas factory fireplace '` <br /> � <br /> Wood burning factory fireplace with flue ;- <br /> ��. <br /> Wood Stove ,, <br /> Wood stove with flue '� <br /> ;� <br /> Brand Name ������. �-7� � Model No. L C�S�� �(� � <br /> i� <br /> � <br /> VENTILATION �' <br /> No. Kitchen E�aust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <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 /> LP Gas: gallons <br /> Other Gas opening <br /> PERMIT FEE CALCLTLATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> �� � 3 y �' X .o12s $ <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ <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 co the customer <br /> for the work done. If any material, equipment, labor, or installation are furnished by the ow�ner, 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 �reater. <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, aQrees 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 /> �� ��`' L <br /> � <br /> Applicant's Signature: ����� - � t�'� ��.�i^^�IG'+� Date: � i � � r�� <br /> � <br /> Approved By: Date: <br />