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� 1 <br /> , , , • <br /> , .�. . , <br /> , , , � <br /> . . _ . . . . - l l.�Y.� . . <br /> . .... .'.{� <br /> S <br /> FIREPLACES ' <br /> �� <br /> Gas factory fireplace <br /> Wood burning factory fireplace with flue <br /> Wood Stove <br /> Wood stove with flue <br /> Brand Name Model No. <br /> VENTILATION f <br /> No. Kitchen Exhaust ducted recirculating cfm `` <br /> No. � Bath Exhaust (must be ducted outside) �0 cfm -- ��--c-1- ,5" <br /> .�. <br /> No. Other Fans: Locations cfin <br /> � <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE NLARSHAL) <br /> Installation Removal � <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) �-- <br /> l$, 5�60 x .0125 $ a 3). 2S <br /> (contract price) <br /> 2. State Surcharse. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ � ' 2� <br /> or $.50, whichever is greater (concracc price) <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ a�o� � � � <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 <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 /> ** The STATE SURCHARGE is .0005 of the contract price under 51,000,000 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 /> Applicant's Signature: ' Date: �"" 24 — bC� <br /> Approved By: �� Date: S —I —O� <br />