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f <br /> S <br /> r <br /> FIREPLACES <br /> Gas factory fireplace <br /> Wood burning factory fireplace with flue <br /> Wood Stove <br /> � Wood stove with flue ` �� �, . -.�� <br /> Brand Name �� � �ti� � ���1 Model No. J��� <br /> VENTILATION <br /> No. Kitchen Eachaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfr_� <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 CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee 35.00 <br /> ) � x .0125 $ ,37, 5� <br /> (c ntract price) <br /> 2. State Surchar�e. �`�` Add the State Building Code Division <br /> Surcharge to each permit. � � �� x .0005 $ j,�� <br /> or $.50, whichever is greater contract price) <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �, SQ <br /> * CONTRACT FnICE or JOB CQST me�s :he actual or es?ima!ed dollar amount charaed 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 /> �� �l�/�-dr�3 <br /> � �, <br /> Applicant's Signature: � �--����'� '� ��� � Date: ��0�7���� <br /> Approved By: Date: <br />