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�. <br /> r <br /> � <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 /> ����-v<-� � vG`,�-�'� ��,,�L ,,'����c�—. <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> �vt� �1� No. % Bath Exhaust (must be ducted outside) cfm <br /> No. ., _� Other Fans: Locations ,��.-� C��� cfm <br /> y— �?c�� :��� �� <br /> FUEL STORAGE (MUST BE APPROV D�Y 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 �'ee ($35.00� ' <br /> l�' �SC` �-- x .0125 $ <br /> (contract price) <br /> 2. State Surcharae. "* Add the State Building Code Division <br /> Surcharae to each permit. x .0005 $ <br /> or $.50, whichever is greater (contract price) <br /> 3. Postage and Handlin� (Only mail-in applications) $ 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 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 tl�e 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: �C �"� Date: � �..�r3r.�/ <br /> Approved By: Date: <br />