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<br /> ��- FIREPLACES °�x
<br /> Gas factory fireplace � `�
<br /> - �.
<br /> Wood burning factory fireplace with flue � �:
<br /> Wood Stove
<br /> Wood stove with flue � �
<br /> Brand Name Model No.
<br /> ,u-,
<br /> �;r � r
<br /> � � � VENTILATION ,�: �s,�a `" �-�
<br /> ��`` I�o. Kitchen Exhaust ducted recirculating cfm �
<br /> ,.,' No. �_ Bath Exhaust (must be ducted outside) � cfm �
<br />�` No. Other Fans: Locations cfm �3
<br /> ';• , , FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) ��
<br /> `"� Installation Removal �;
<br /> 3"{'
<br /> ��` Fuel oil: gallons underground inside outside #
<br /> '."': LP Gas: gallons �
<br /> ,�� �
<br /> '� Other Gas opening F :�
<br /> �' �.���" ,�
<br /> PERMIT FEE CALCULATION . � � � `�''`� � �� �'�"�
<br /> `�:.
<br /> 1. 1.25% of Contract Pri or Minimum Fee ($35.Q0) � '' ` '
<br /> x .O1 5 $ '�`
<br /> �SdG , `�' _ ,�i
<br /> ,�' ,, (contract price) �
<br /> � 2. State Surchar�e. ** Add ttie`�fat�Bui�t�i�g Eode Division �
<br />' ,,. � Surcharge to each permit. x .0005 $ ,;{
<br /> ;_5;;; or $.50, whichever is greater (contract price) �'
<br /> '�;
<br /> ,:,
<br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 ;
<br /> �, -.. . 4. TOTAL PERMIT FEE (Add lines 1-3 above) $
<br /> ,-.�x;7, �
<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted
<br /> ���ork 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 /> �
<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 � 4,°;
<br /> request the submission of a signed copy of the actual contract.
<br /> `��
<br /> ** The STATE SURCHARGE is .0005 of the contract price under$1,000,000 or $.50 - whichever is greater. �'
<br /> ,;,,
<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 an the regulations of the Minnesota
<br /> State Building Code, and certifies that all statements made o this` pplication are complete, true
<br /> and correct. �
<br /> �..__.._.
<br /> _ =-
<br /> Applicant's Signature: ; - . Date: �
<br /> Approved By: Date:
<br />
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