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r <br /> FIREPLACES <br /> � Gas factory fireplace <br /> Wood burning factory fireplace with flue <br /> Wood Stove <br /> Wood stove with flue <br /> Brand Name c��/,�'�'y�--ll�"l� Model No.,�/���� �-�1�� <br /> VENTILATION <br /> No. Kitchen Elchaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfrn <br /> No. Other Fans: Locations �� <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) - <br /> Installation • Removal <br /> Fuel oil: . gallons underground inside outside <br /> LP Gas: T gallons - <br /> Other � Gas opening <br /> PERMIT FEE CALCULATION - <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) , � <br /> x .0125 $ <br /> - (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division � <br /> Surcharge to each pernut. x .0005 $ <br /> or $.50, whichever is greater - (contract price) <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. 3'OTAL 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 mazket value of such items must be added to the estimated cost or contract <br /> price for pernut 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 /> Applicant's Signature:/ � �1i11-� Date: � 1 e� <br /> Approved By: Date: <br />