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\^. <br /> � R <br /> C�2 5 � i u-e5 �-�O •. � -�-�re.��a c.e S, 1 (J rc�-e r� 1 � �Q � ' �' <br /> U c� "J <br /> FIREPLACES <br /> Gas factory fireplace <br /> Wood burning factory fireplace with flue <br /> Wood Stove <br /> , <br /> Wood stove with flue _� <br /> Brand Name Model No. <br /> ��VENTILATION ( ,�,��`}�r� � <br /> No. �_ Kitchen Exha��f} ducted recirculating cfm <br /> No. � Bath Exhaust (m su�t be d ted outside) cfm <br /> No. �, Other Fans: Locations f � cfin <br /> 1 �� �`'� �Ve-�{ ��-vV� �v�.S . c�•� <br /> F 6 FUEL STORAGE (Mj�s I' BE APPRO�D BY FIRE MARSHAL) <br /> Installation Removal �5 <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br />�:� PERMIT FEE CALCULATION <br /> 1. 1.25%o of Contract Price* or Minimum Fee ($35.00) <br /> Ct?��� , (�(� x .0125 $ � �� • 02� <br /> (contract price) <br />�.��. <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. Cj ' Q�� ,��� x .0005 $ � ,(Q� <br /> or $.50, whichever is greater (concracc price) <br /> ;� <br />.�r 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 `' <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ � �. I � �(`� y <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> work including materials,labor,proTlt, 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 the job cost, the City may <br /> �, request the submission of a signed copy of the actual contract. t; <br /> � <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, aarees 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: <br /> Approved By: Date: <br /> i, . , <br /> '`` _ . ;� _ _. . <br /> . �,. . . _ �� e ,. . <br />