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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 cfin <br /> No. Bath Exhaust (must be ducted outside) cfin <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 (�(},� --�(� ��Q�`� Q'(1C\ C1`� Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.001 � <br /> �j���� x .0125 $ �� � � <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Buildin� Code Division _-� <br /> Surcharge to each permit. ���') x .0005 $ ' � <br /> or $.50, whichever is greater (concracc price) <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 3� _ �� <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> �.rerk i.��l���i�b mate*�als,lzb�r,pr�fit, and ottzer fi�e�c�sts. It is the:.^i�.u:t to�e charged:a th:,cu:,tome: <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 estunated cost or contract <br /> price for permit fee pnrposes. 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 Pernut, 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 /> an� correct. <br /> Applicant's Signa e: �� �� � Date:S � <br /> y <br /> Approved By: Date: <br />