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� i <br /> FIREPLACES - ��� i''-�Ii�V� �l�C- �•.. C.>/�} C.���.�c., i-��-� ` �'` <br /> Gas factory fireplace � � L��i� � T� �L-���+w� c� �-- <br /> Wood burning factory fireplace with flue ��v� ��� �1 vv+5 u�� <-'-�-�-`"� <br /> Wood Stove , - +c_c,�v�,.t;; c� � ;� F,v�.� ���e�.-, <br /> Wood stove with flue ;�- ���'�����s� r� �`�>'�-�'� <br /> ._ �_ ;� , ,;-� . <br /> Brand Name Model No. <br /> VENTILATION <br /> No. Kitchen E�aust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <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 Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25�� of Contract Price* or N,[inimum Fee ($35.00) �_ <br /> /j�% �� �- <br /> ' x .0125 $ � <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division , , �, <br /> Surcharge to each permit. _ / `%" -'; ` x .0005 $ <br /> or $.�0, whichever is greater (contracc price) <br /> 3. PostaQe and Handlin� (Only mail-in applications) $ 1.50 <br /> �.�� �� �� <br /> 4. TOTAL PERMIT FEE (Ac�d 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 /> 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 .00OS 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 Buildina Code, and certifies that all statements made on this application are complete, true <br /> and correct. �� �'� � 1 , -�� � �� <br /> /' �/ � ,/'��)� � '� <br /> Applicant'sSiQnature:j / '�,t�/ �/ ' 1c��-�---� Date: �� �7 �`� <br /> Approved By: Date: <br />