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<,: <br /> , r,,.�'�" <br /> -- � <br /> ;:h;�; <br /> �':� <br /> �-: <br /> FIREPLACES ��� <br /> �;" ��� Gas factory fireplace <br /> Wood burning factory fireplace with flue <br /> Wood Stove <br /> Wood stove with flue <br /> � � .;, <br /> Brand Name �����1�t G ^!�lr.f-�� �' Model No. %L���/� ��Z ��i��� <br /> :,', <br /> VENTILATION r;� <br /> No. Kitchen Exhaust ducted recirculating cfm :�F <br /> No. Bath Exhaust (must be ducted outside) cfm '�� <br /> ��. <br /> No. Other Fans: Locations cfm z <br /> - FLTEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) �:� <br /> Installation Removal �;� <br /> ,,� <br /> Fuel oil: gallons underground inside outside J <br /> LP Gas: gallons <br />,r; Other Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> ' � l'�poc� . �� x .0125 $ <br /> G,� <br /> (contract price) <br /> �'�:,. 2. State Surchar�e. ** Add the State Building Code Division <br /> � �� Surcharae to each permit. x .0005 $ <br /> :> or $.50�whichever is greater (contract price) <br /> ,f <br /> i :' 3. Postage and Handlina (Only mail-in applications) $ 1.50 <br /> r ry : . <br /> �' 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ <br /> i;'_ <br /> * CONTR�CT 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 <br /> ,± request the submission of a signed copy of the actual contract. �� <br /> ,,._,�. <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, 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 /> =� :� <br /> Applicant's Signature: �'�� �-- - Date: ��-��—�C� <br /> Approved By: Date: <br />