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� � <br /> � <br /> FIREPLACES �� <br /> � <br /> Gas factory fireplace �j ► <br /> Wood burning factory fireplace with flue I � lj��� <br /> Wood Stove � <br /> Wood stove with flue '�� <br /> Brand Name Model No. <br /> VENTILATION <br /> No. Kitchen E�aust ducted recirculating cfm <br /> No. �_ Bath E�aust (must be du ted outside) cfm <br /> No. �_ Other Fans: Locations ^ �,/' �.L �� <br /> FUEL STORAGE (MUST BE APPROVEI? BY FIRE MARSHAL) <br /> Installation Remo <br /> Fuel oil: gallons undergrou inside outside <br /> LP Gas• gallons <br /> O r Gas opening <br /> � <br /> PERiI�IIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> 7�;�;�� =- x .0125 $ <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 /> . _ . , . . � ..,,.�,«.�w,.w�F.�■.r.s,r...� . <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 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 Ciry 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 witli the ordinances of the Ciry and the regulations of the Muinesota <br /> `� ` State-Building Code; and certifies that all statements_made on,this application are complete, true <br /> and correct. , ��: <br /> APPlicant'sSignature: a ;�.��-\��� � ' Date: ,:I j. _:1;� � ;: <br /> -�- <br /> Approved By: Date: <br />