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<br /> FIREPLACES � ` "
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<br /> Gas factory fireplace ����� � ,
<br /> " Wood burning factor�� fireplace with flue � f�'; , :
<br /> Wood Stove "�r
<br /> ' `'4 ' Wood stove with flue
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<br /> ��'' Brand Name Model No.
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<br />�::�z:; 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 Remo��al
<br /> Fuel oil: Qallons underground inside outside
<br /> LP Gas: gallons
<br />� Other Gas opening :
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<br />`�` ' PERMIT FEE CALCULATION � ; { ;��;�
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<br /> 5,: 1. 1.25% of Contract Price* or �Ii ' um Fee 35.00 �"
<br /> = _�20�.oC� x .0125 $
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<br /> �� `�,' 2. State Surchar�e. ** Add the State�uilding Code Division �
<br /> ��� Surcharge to each permit. ��OCri.�O_ x .000� $ ` ``
<br /> or $.50, whichever is greater (contract price) ���`:�'�
<br /> 3. Postage and Handlin� (Onl�� mail-in applications) $ 1.50
<br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $
<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 y�
<br /> � any other party the reasonable market value of such items must be added to the estimated cost or contract + '.
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<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. '
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<br /> ** The STATE SURCHARGE is .000�of the contract price under$1,000,000 or $.50 -whichever is greater. �:
<br />�? For valuations over $1,000,000 call the Department of Inspectional Ser�-ices for the price.
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<br /> r:;� The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do all �
<br /> a;; work in strict accordance with the ordinances of the Ciry and the reQulations of the Minnesota '
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<br /> State Building Code, and certifies that all statements made on this application are complete, true ��
<br /> and correct. 't
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<br />� Applicant's Signature: Date: // .2$ aQ0 y' ��
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<br /> Approved By: Date: F '� :
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