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�� <br /> -s ;: <br /> FIREPLACES <br /> Gas factory fireplace ��'x�'� <br /> Wood burning factory fireplace with flue <br /> Wood Stove <br /> Wood stove with flue <br /> ;;� <br /> Brand Name Model No. {'r� <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm „ _; <br /> No. Bath E�aust (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: allons <br /> : �, g <br /> Other Gas opening <br /> PERMIT FEE CALCULATION <br /> �� 1. 1.25% of Contract Price* ar Minimum Fee ($35.00) -::�� <br /> �� �5 0 � x .0125 $ � '3S . 00 - <br /> (contract price) �'� <br /> 2. State Surchar�e. ** Add the State Building Code Division ''�� <br /> Surcharge to each permit. x .0005 $ � � � �7 <br /> or $.50, whichever is greater (contract price) a;, <br /> rc � <br /> .` Y �^K <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 �` r � <br /> Y., '� } <br /> ,:� <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �3�• S 9 �� <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> work ir.cluding materizls, iabor, prefit, anu other fi�ed costs. I:is the a.�r:ourt te be chargeu to the custeme: <br /> for the work done. If any material, equipment, labor, or installation are furnished by the owner, tenant or `�' <br /> any other parry 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 contracL '�•,, <br /> ��, <br /> ** The STATE SURCHARGE is .0005 of the contract price under$1,000,000 or $.50 - whichever is areater. - <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: - - - Date: � a.0 O � <br /> Approved By: Date: <br />