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� <br /> � <br /> FIREPLACES <br /> Gas factory �replace <br /> Wood burning factory fireplace with flue <br /> Wood Stove <br /> Wood stove with flue <br /> Brand Name Model No. <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <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: gallons <br /> Other Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($3�.00) , <br /> ;:;�� ' �:,; i � X .0125 $ �)��� .��'�C'�� <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division , ; � <br /> Surcharge to each permit. '� �{` '�� � � � x .0005 $ • ''�\ <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�:e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ r` ' ? , <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> work including r,laterials, laho,,profit, anu cu'�e:fixed coscs. T.:is*�he amoLnt to be charged to the customer <br /> for the work done. If any material, equipment, labor, or installation are fumished 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 S1,000,000 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 /> - - > �, � <br /> Applicant's Signature: ___ ~ ,' - i_--- � Date: • `) _ '`� - ; , ; <br /> _ � <br /> Approved By: Date: <br />