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� <br /> J � <br /> FII7EPLACES <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 <br /> No. Kitchen Exhaust ducted recirculatin�_cfin <br /> No. Bath Exhaust (must be ducted outside) cfin <br /> No. Other Fans: Locations cfin <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation ❑Removal <br /> ❑ Fuel oil: u 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 /> 4000. x.0125 $ Gi C � �'� <br /> (contract price) <br /> 2. State Surchar�e. **Add the State Building Code Division <br /> Surcharge to each permit. 4000. x .0005 $ � � L � <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) $ S,� -��� <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$1,000,000 or$.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 the 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 Signature: � Date: 10/01/2001 <br /> Approved By: Date: <br />