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f � . -�• . � . . . . .. . .. .. _ �. <br /> r K , ! �1 ._. `. , . . <br /> ���, ! <br /> � �L�'.� . . . <br /> .. � ,y ��.� 'I�., � . <br /> FIREPLACES � <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 /> '.� <br /> �,� VENTILATION <br /> � No. J Kitchen EJchaust � ducted recirculating Z v o cfm <br />�` No. Bath Exhaust (must be ducted outside) cfm <br /> 1\T�, QtrPr Fanc: T n��t1�JriS CfITI <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 />�;�:. <br />�F' PERMIT FEE CALCULATION <br /> 4'_,' <br /> x� 1. 1.25% of Contract Price* or Minimum Fee ($35.00) / <br />�{; J��o o x .0125 $ � � <br />��; (contract price) <br />�� 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. S,��a x .0005 $ Z. � D <br /> t'�; or $.50, whichever is greater (contract price) <br /> <'�: <br /> ;;x, <br /> t 4; 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> A 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 6 9• !� <br />'`" * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> �;:,rl:inc:uding matcrials, labor,�rofi:, a.-�d other tixed costs. It is the ame�:nt:e he charged tc the_ns:�mer <br />%,'r` 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 <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 />�cv <br /> r�. <br /> For valuations over $1,000,000 call the Department of Inspectional Services for the price. <br />=:i° <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 11 state s made on this application are complete, true <br />�';f and correct. �� <br /> ,� � <br /> Applicant'sSignatu : � ,/��— (I� �n��s ,�. ��r-laz�Date: � �� �0 <br /> Approved By: Date: <br />