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Y a �\. , ._t , '' • <br /> ��N .. . : . , . ... ". t� t: t y .. . . � (� <br /> � . -. . .. . . , � ' . � �1� . ,,.. . . . i. ,�.�+� <br /> t <br /> C <br />�';� FIREPLACES ' � � � '�� <br />,�: �s factory fireplace �� � �� � ��'�P� ,�� <br />��" Wood burning factory fireplace with flue ;;- � . <br /> Wood Stove ��" <br /> '� Wood stove with flue - ' <br />.:x� . � <br /> k 4'�3 <br /> Brand Name t�-1 C-.�--t—N -- G� �-� Model No. S�-'�5 C� �R' � <br /> x� <br /> _ t�,� <br />..,�;� <br /> _;t <br />�°� VENTILATION <br />�:�; No. Kitchen Exhaust ducted recirculating cfm <br />�•.� <br />�- No. Bath Exhaust (must be ducted outside) cfm "�'' <br /> �, <br />��'' No. Other Fans: Locations cfm V`' <br />�: :i� <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br />�..:: ' <br /> Installation Removal ' .;� <br />��{ Fuel oil: gallons underground inside outside <br />� > LP Gas: gallons <br /> Other Gas opening <br />�,;: <br />$-�� PERMIT FEE CALCULATION � V'� <br />,-� � ���a<.'��_ <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br />�::: �3�!`? � o � x .0125 $ "3S , e,�-O <br /> �`, : ' (contract price) <br /> ��_'f <br /> � 2. State Surchar�e. ** Add the State Building Code Division <br />�� `` Surcharge to each permit. x .0005 $ 1 . l r? <br />£`�`� or $.50, whichever is reater (concract rice) <br /> Fx g P <br />�� <br />�,_,. <br />�,' 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br />�. '�- <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ � � . 1 `t <br />- - * CONTRACT PRICE or JOB COST means the acmal or estimated dollar amount charoed for the permitted <br />�'� work including materials, labor,profit, and other fixed costs. It is the amount to be charged to the customer '; <br />>"p for the work done. If any material, equipment, labor, or installation are furnished by the owner, tenant or ? <br /> ;� <br /> 4.6' <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 />��.. <br /> ;_� <br /> �. <br />�'= ** The STATE SURCHARGE is .0005 of the contract price under�1,000,000 or $.50 - whichever is greater. :; <br />�� w <br /> For valuations over $1,000,000 call the Department of Inspectional Services for the price. <br /> °:� <br />`g� The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all X <br />�-�, �' work in strict accordance with the ordinances of the Ciry and the regulations of the Minnesota � <br /> � 1 State Building Code, and certifies that all statements made on this application are complete, true `.� <br />� a. � <br /> x and correct. <br />�>, <br /> kk"�� Applicant's Signature• Date: $ '3�-�'� ( <br />_:. - � <br />��� <br /> Approved By: Date: ' <br /> i�;` <br /> _ ,, <br />��; , - .. <br /> �� _ <br /> . . '?, . .� 1 .. _ f. . <br />