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� <br /> �� � <br /> y e <br /> I <br /> FIREPLACES " <br /> Gas factory fireplace <br /> Wood burning factory fireplace with flue <br /> Wood Stove <br /> Wood stove with flue <br /> ° Brand Name Model No. <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfin <br /> No. Other Fans: Locations �� <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.,0�0 <br /> � ,r"'� x .0125 $ ��j� C�� <br /> (contract price) <br /> 2. State Surchar�e. ** Add the S�te Building.Code Division <br /> Surcharge.to each permit. ',1���, � x .0005 $ � o t�� <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e 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 dollaz amount chazged 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 mazket 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 Deparnnent of Inspectional Services for the price. <br /> � The undersigned hereby applies to the City for issuance of a Mecha.nical 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 sta.tements made on this application are complete, true <br /> and correct. <br /> Applicant's Signa . ` Date: ' I �CJ� <br /> Approved By: Date: <br />