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! � � � �� � ��e�..�.�s <br /> ,�f , �-�l � � e�� �y s �� cis /�t.e..5 � � '�''`-� '� . <br /> �� � 1 � � . <br /> FIREPLACES <br /> Gas factory fireplace <br /> Wood burning factory fireplace with flue <br /> Wood Stove <br /> Wood stove with flue <br /> � - ����5 (�j �> <br /> Brand Name � E�,� �,, LS Model No. S L�-C�. �� 1�j <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (inust be ducted oatside) 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 CALCULATION } <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> ��� S Z-'`�r� x .0125 $ <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ <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) $ <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 tha�all statements made on this application are complete, true � <br /> n and correct. � <br /> � / ` <br /> F �. Applicant's Signature: �,/� �/ Date: , <br /> Approved By: Date: <br /> ,, <br /> ��:_�s _:. <br />