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i <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. __ ��- Locations �(,, �ti�`'?f lL.�� C ��� <br /> ,'t�t;�.. fi �' •� `c��m�C� ���r�9_� , K�.�tLN`'"�'� � <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) ���,�15��+� �jg;,��,'�'• <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 ($3�.00) � <br /> 1 S�, x .0125 $ �'_i��.% - <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 /> 3. Postage 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 /> �:�ork including materials, 1.abor,profit, and other fixecl 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 certifies that all statements made on this application are complete, true <br /> and correct. <br /> Applicant's Signature: �,,✓,��lL�'G�� Date: , �� � �C�� <br /> Approved By: Date: <br />