Fillable MECHANICAL PERMIT APPLICATION (City of Cottage Grove)

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MECHANICAL PERMIT APPLICATION (City of Cottage Grove)

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DENMARK
TOWNSHIP
MECHANICAL
PERMIT APPLICATION
12800 Ravine Pkwy S, Cottage Grove, MN, 55016 Phone: 651-458-2804
Email: building@cottagegrovemn.gov Website:www.cottagegrovemn.gov
OFFICE USE ONLY
Permit Number:
PROJECT ADDRESS:
OWNER/OCCUPANT INFORMATION:
Name:
Phone:
Address:
State:
Email:
CONTRACTOR INFORMATION:
Name:
Phone:
Address:
State:
Email:
State License/Bond #:
Contact Name:
APPLICANTS SIGNATURE:
Applicant certifies that all information is correct and that all pertinent state regulations and city ordinances will
be complied with in performing the work for which this permit is issued.
Printed Name:
Date:
Signature:
Date:
PROJECT VALUE
PROJECT DESCRIPTION
$
RESIDENTIAL FEES
Base Fee: $50 (includes 1 fixture) – Add $10 for each additional fixture
New Single Family Dwelling $200
Furnace
$10
#
Fireplace
$10
#
Air Conditioner
$10
#
Garage/Unit Heater
$10
#
Air Exchanger
$10
#
Gas Appliance
$10
#
Boiler
$10
#
Gas Piping
$10
#
Duct Work Only/Extension
$10
#
Heat Pump
$10
#
Exhaust Fan
$10
#
In Floor Heat
$10
#
Other/Misc.:____________________________________________________________________
$10
#
License Verification Fee $5.00
State Surcharge $1.00
COMMERCIAL FEES
Project Value (materials & labor)
$
Permit Fee (project value x .02 or $75, whichever is greater)
$
State Surcharge (project value x .0005)
$
TOTAL:
$
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MECHANICAL PERMIT APPLICATION (City of Cottage Grove)

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Completed 21 January 2021

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