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<br /> FIREPLACES
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<br /> Gas factory fireplace r � yM
<br /> Wood burning factory fireplace with flue Lh; � �-'
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<br /> Wood Stove p� '�<<.
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<br /> Wood stove with flue '�'
<br /> Brand Name Model No. °x�
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<br /> :�: ' VENTILATION �i
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<br /> f � � No. �_ Kitchen Exhaust � ducted recirculating cfm ''�
<br />� No. Bath Exhaust (must be ducted outside) cfm �L�'
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<br />�� , No. Other Fans: Locations _ __ cfm
<br /> $ ' FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) �
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<br />�� ��� Installation Removal � �
<br />_ �' ���� ��� Fuel oil: gallons underground inside outside ° ��`�
<br /> R �. � LP Gas: gallons ,�
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<br /> Other Gas opening �
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<br /> PERMIT FEE CALCULATION
<br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) "
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<br /> ��o -oo X .oi2s � � 5-00 �
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<br />�, (contract price) ' `
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<br /> 2. State Surchar�e. ** Add the State Building Code Division ` 5,O �
<br /> � Surcharge to each permit. x .0005 $
<br /> b� '` or $.50, whichever is greater (contract price) ,�,;
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<br /> � 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 r, � " �
<br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 3�•�� � �3� '
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<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 the job cost, the City may `";� 'y�'.
<br /> � request the submission of a signed copy of the actual contract. ``� ` �``
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<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. 4;
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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. — �'
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<br /> Applicant's Signature: � l���'`' v Date: � ��,Q 'Q�
<br /> � ;f::�::, Approved By: Date:
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