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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 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 cfm
<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
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<br /> PERMIT FEE CALCULATION v
<br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) `' -'��
<br /> �?,�n� `� x .0125 $ ��. �� ; � "F
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<br /> (contract price) =;f��
<br /> 2. State Surchar�e. ** Add the State Building Code Division
<br /> Surcharge to each permit. ���� �== x .0005 $ l��J r
<br /> or $.50, whichever is greater (concract price) ,� ' ��
<br /> 7 = �
<br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50
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<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 wark 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. ,�
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<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: �2 C�
<br /> Approved By: Date:
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