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. , <br /> _ � - � <br /> FIREPLACES <br /> I Gas factory fireplace t,� � i.i i-,'� i.>: ,�r�.-f i; {-�•�--t <br /> ; Wood burning factory fireplace with flue <br /> Wood Stove <br /> Wood stove with flue <br /> . , <br /> Brand Name ' Model No. <br /> VENTILATION <br /> No. Kitchen Exhaust ducted � recirculating cfm , <br /> No. / Bath Exhaust (must be ducte utside) a cfm � � r% �.�'"`�;"�`���� /. <br /> , ,,�,i � <br /> No. � Other Fans: Locations �/ ���.':� �� ��,�»-S�� v` `"cfin � �- �/�,,Q,1�� <br /> ' � _ �<J � <br /> � <br /> FUEL STOR�GE �1v1U�i i�E APritOV�E� B Y' FIRE tiiARST-i�ii;j " � <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 Minimum Fee ($35.00) <br /> ��v�� x .oi2s � ��7 S� <br /> J (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. Posta�e and Handlin� (Only mail-in applications) $ _ --�&- <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 charged to the customer <br /> for the work done. If any material, equipment, labor, or installation are furnished by the owner, tenant or <br /> anv other oartv 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 /> �-� ,.�' <br /> � j , <br /> .- �_---� <br /> = ' . .::�-.� <br /> �- <br /> Applicant's Signature: ,�i• � - --�-,---� - — ------- Date• �� �-�`� <br /> � <br /> .-----_`.� <br /> Approved By: Date: 2-c�� `�� <br />