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, � <br /> FIREPLACES <br /> Gas factory fireplace <br /> Wood burnin� factory fireplace with flue <br /> Wood Stove <br /> W�od stove «�ith flue <br /> Branci i�iame iviodci i�u. <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. �_ Bath Exhaust (must be ducted outside)�� cfm <br /> No. Other Fans: Locations cfm <br /> �C,v�r�c� IY=QGZ1�� �`'�5't-�.� '. c"�V�`�� �, <br /> FUEL STORAGE (MUST B�PPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: Qallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas openin� <br /> PERMIT FEE CALCULATION <br /> l. 1.25% of Contract Price* or Minimum Fee ($3�.00) `f , <br /> ��� . �U x .O 12� $ �-1��C� <br /> (contract price) <br /> 2. State SurcharQe. ** Add the State BuildinQ Code Division <br /> Surcharge to each permit. �.( , x .0005 $ <br /> or $.50, whichever is greater (con�racc price) <br /> 3. Postaae and Handlina (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ —��,-,--t�`a�_ <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 furnisbed 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 si�ned copy of the actual contract. <br /> ** The STATE SURCHARGE is .000� of the contract price under$1,000,000 or $.50 - whichever is grea[er. <br /> For valuations over $1,000,000 call the Department of Inspectional Services for the price. <br /> Tre undersigned hereby applies to the Gity 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 /> Applicant's Si;n e: <br /> � � /� Date: `�p� <br /> Approved By: Date: <br />