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.. � .: _ ... . . ` r� �f# �� '..�.�,. ._ . . = t...��,.,_ <br /> 'rF � t . <br /> � y �' �. . . � . <br /> ' '0. � • . + . .�� �} . - � �� . . � <br /> .. vt'r. . ., . . .. . . <br /> { °.i'��ee '. . . . . � � <br /> Y V y <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) cfm � <br /> No. Other Fans: Locations cfin <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 �,S 1 i� -f'��--.�}�,,��.�. � Gas opening <br /> PERMIT FEE CALCULATION . <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.001 �-- � <br /> ' �' x .0125 $ � <br /> `��._.,��:J <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surc`��rge to each permit. <�;F, ` ''� � x .0005 $ ��O <br /> Ao(�i l A/ <br /> or $.. �, whichever is greater (contract price) <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 chazged to the customer <br /> for the woric done. Yf any material, equipme�it,iabor, or installaticjn are furnisned by the ov:ner,tenaat 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 puposes. 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�e 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 Ciry 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 conect. ` � <br /> � _ _ � <br /> Applicant's Signature•i Date: <br /> l <br /> Approved By: Date: <br />