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� <br /> i <br /> FIREPLACES <br /> � Gas factory fireplace �-t ti� �i.� �7-tae c- <br /> /rr`J �_ Wood burning factory fireplace with flue �� ti'��� {4si-�8� <br /> �� Wood Stove <br /> Wood stove with flue <br /> Brand Name S��. ,��/,�� Model No. <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 /> 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 /> l. 1.25% of Contract Price" or Minimum Fee ($35.00) <br /> ��,�;X, x .0125 $ �O-�� <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. ��cx: �� x .0005 $ �-� <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ •�! <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 7�.J'� <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 certif�ies that all statements made on this application are complete, true <br /> and correct. <br /> Applicant's Signature: Date: n�v o _ <br /> , - <br /> Approved By: Date: <br />