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.. � �Fr �1�' +'A n ✓�`� !v�, �b J' � t'o- Jiy £� ��..� s s 2,� W �.,� . .��1 � �` _ <br /> -,.. ... .. �. <br /> . a ,Y S�,'�.0 ,���o � „'� '1. �� q' ' h j� �.�AM' y ��1 M r t t �; � � �� ,s } . <br /> T.�..: : ,�t° �'� Rv . � e� � � a'3,', `�` . <br /> - � �` ,� ..F ,�y`� t . • <br /> . .. }.' .t { Y - f"- 3 � ¢;.' <br /> . ' . s^iw 4-S . S� . ` (L y''r 'f� ��N_ . .. �� _ . . if � . . ' . . <br /> FIREPLACES . � � ��' - � "�.� ; x"' � � �_�� ' <br /> �� '�; ;� <br /> Gas factory fireplace } � � <br /> Wood burning factory fireplace with flue � i . ,E;' � <br /> Wood Stove � � . '4 : <br /> Wood stove with flue , s 1,;,, �" <br /> ' � . - - � ' 3r+��.�4` 4}' <br /> Brand Name Model No. <br /> �. <br /> VENTILATION � =:�- � <br /> No. Kitchen Exhaust ducted recirculating cfin >��, ,: � <br /> No. Bath Exhaust (must be ducted outside) cfm <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 M'nimum Fee 35.00 ' <br /> � �� x .0125 $ <br /> contract price) <br /> 2. State Surcharge. ** Add the ate Building Code Division /� <br /> Surcharge to each permit. ��j,�� [7,�� x .0005 $ �V <br /> or $.50, 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) $ �n� , J� <br /> � <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> work including materials,iabor,profit,and ocher fixed costs. It is��amouni io bc cha;gcd to the customer <br /> for the work done. If any material, equipment,labor, or installation aze fumished 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 perposes. In the eYent 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 Ciry for issuance of a Mechanical Permit, agrees to do all <br /> work in strict accordance with the ordinances of the Ciry and the regulations of the Minnesota <br /> State Building Code, and certifies that all statements made on this application are complete, true <br /> and correct. ' -... ' . <br /> � . . / � <br /> Applicant's Signature: Date: <br /> Approved By: Date: :. <br />