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. ., ; , . ,�, �� <br /> ,. . ,.. <br /> FIREPLACES <br /> Gas factory fireplace a��� <br /> Wood burning factory fireplace with flue � <br /> Wood Stove �� <br /> Wood stove with flue `� <br /> � <br /> � <br /> Brand Name Model No. �� <br /> � <br /> � <br /> VENTILATION � <br /> No. Kitchen Exhaust 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 /> � <br /> � <br /> Installation Removal .� <br /> Fuel oil: gallons underground inside outside � <br /> LP Gas: gallons � <br /> _,� Other _(�,��.a;;`,�,, �,q � 1� Gas opening � <br /> i'r <br /> PERMIT FEE CALCULATION '� <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) � <br /> (nt7"1�. Loy� X .�I25 � i <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division � <br /> Surcharge to each permit. (���<_4?,�,� x .0005 $ �� <br /> or $.50, whichever is greater (contract price�) � <br /> � <br /> � <br /> 3. Postage and Handling (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 /> 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 .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 /> R� <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all `'�i <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 /> (l1J�,�.��,��5�.�.�- <br /> A licant's Si nature: y� � D • i�� -z,`� -C� 1 '�t <br /> pp g �.�- ate. <br /> � ' � <br /> Approved By: 1--� �..... Date: f af���a/ <br /> ,: <br /> �� <br /> P� � � �.�� G�y �.� ��-�- �W�� ,�,ti.�r � <br /> �� <br />