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� <br /> FIREPLACES <br /> � Gas factory fireplace <br /> Wood burning factory fireplace with flue <br /> Wood Stove <br /> Wood stove with flue <br /> Brand Name �v��`72/cfi� Model No. �/��vO C�'`-l� `� <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outsidz) cfm <br /> No. Other Fans: Locations cfm <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE �L�RSHAL) <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 ($3�.00) <br /> ,' UDO. °" x .012� $ <br /> (contract price) <br /> � 2. State Surchar�e. ** Add the State Building Code Di�-ision <br /> '; Surcharge to each permit. x .000� $ <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handlin� (Only mail-in applications i $ 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 inst.!lation are furnished by the owner, tenant or <br /> any other party the reasonable market value of such items m��.�.�: be added to the estimated cost or contract <br /> price for permit fee purposes. In the event that there is a dispu:e 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 S1,000.000 or $.50 - whichever is greater. <br /> For valuations over $1,000,000 call the Department of Inspec:ional Ser��ices for the price. <br /> The undersigned hereby applies to the City for issuance of a �Iechanical Permit, agrees to do all <br /> work in strict accordance with the ordinances of the Cin 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 /> Applicant's Signature:/'- �-�� � Date: �7 � <br /> Approved By: Date: <br /> �� <br /> s _ : �, <br /> ,, ��.a._._n__. _. .,��,.. <br />