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� ' , � <br /> � <br /> . <br /> FIREPLACES <br /> � Gas factory fireplace <br /> Wood burning factory fireplace with flue <br /> Wood Stove + <br /> Wood stove with flue <br /> d <br /> Brand Name �� ,3'���,�� �C Model No. �7(� ,j , �r'Ir"�h'� <br /> ::i-��� �t�X 3��7�'v L�-C � �'u-���='���,��- � u� i�-�r� v"�L�� � m <br /> ��'7� � �c-� c�W S�Q,� �1;�'l�� _ • <br /> VENTILATION <br /> No. Kitchen E�aust 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 /> LP Gas: gallons <br /> Other Gas opening <br /> PERI�IIT FEE CALCULATION <br /> l. 1.25% of Contract Price�` or Minimum Fee ($35.00) <br /> � ���� X .o12s � y�-�� � ��_ <br /> (contract price) <br /> 2. State Surchar�e. �`* Add the State Building Code Division ' <br /> Surcharge to each permit. ��37`�j x .0005 $ � , (p q <br /> or $.50, whichever is greater �concrac�price) <br /> 3. Postaae and Handlin� (Qnly mail-in applications) $ �_� <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ����� <br /> * CONTRACT PRICE or JOB COST means [he actual or estima�ed dollar amount charged for the permitted <br /> work incluuing 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 parry 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, [he City may <br /> request the submission of a signed copy of the actual contract. <br /> '��` The STATE SURCHARGE is .0005 of[he 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 stater�ents made on this application are complete, true <br /> and correct. <br /> I <br /> Applicant's Signature: Date: �� �J�� <br /> Approved By: Date: <br />