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y + � <br /> FIREPLACES � <br /> „ <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 /> ;� <br /> LP Gas: gallons ';a <br /> Other Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> �9c�� x .oizs � y�� ��� <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ l��� <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ,j�Z�� <br /> * CONTRACT PRICE cr JOB COST meuns thc actual ar estimated do;lar amount cha�ged 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 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. <br /> ; <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 /> ::;: <br /> =s� State Building Code, and certifies that all statements made on this application are complete, true <br /> and correct. <br />��� <br /> Applicant's Signature: G�� Date: �`��5-���- <br /> � F <br /> Approved By: Date: <br /> � f �,r - r . eX t - . t � � ��;�. h .t t -. � <br /> � a� s: �.��. <br /> �, ,�w..,....,-... ,. ,. v..r.,s_..�t.Ss.a.at-..�.� ..�.,��:I�����.,��.�m�.a�4'.��... ._. .. �1�.._..�.�r _.. .. ..�e..:�, _.�s...Y.,,k...«._�'�`� ....s•'"�: . _as.' .� . ss........,�.':�.�..n.,.>.,...�t:i <br />