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-� <br /> ;; <br /> � <br /> . � <br /> �'� <br /> °� <br /> FIREPLACES 3 <br /> Gas factory fireplace � <br /> Wood burning factory fireplace with flue £ <br /> Wood Stove � <br /> �: <br /> Wood stove with flue <br /> �:" <br /> Brand Name Model No. <br /> ; <br /> �VENTILATION k� <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 APPRO ED B IF RE MARSHAL) �� <br /> Installation Removal � <br /> Fuel oil: gallons underground inside outside � <br /> LP Gas: gallons <br /> Other Gas opening � <br /> ,� <br /> � <br /> PERMIT FEE CALCULATION `T� <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) _ � <br /> 1�1 � ('1�i s� x .0125 $ � <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. � q , � ��� x .0005 $ � � <br /> E, <br /> or $.50, whichever is greater (contract price) <br /> 3. Postage and Handling (Only mail-in applications) $ 1.50 '' <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �L�� ,�j� � <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> work including materials. labor,profit, and otl:e: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 Ciry may :� <br /> request the submission of a signed copy of the actual contract. � <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 Signatur . Date: , � �' <br /> :r, . <br />���� Approved By: Date: . <br />�� � <br />� � <br />:��. <br />;,;T. <br />::�� <br />