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. ; <br /> t <br /> _ < <br /> WOOD BURNING EOUIPMENT - .� <br /> � 7 <br /> Wood stove with flue � <br /> Wood combination or add-on <br /> Factory fireplace with flue ;� <br /> � Factory Fireplace (s) Freestanding Masonry '�' <br /> Wood Stove (s) Franklin, other �; <br /> Brand Name Model No. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. � <br /> VENTILATION <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 APPROVED BY FIRE MARSHAL) <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* ar Min�um Fee ($35.00) ..� / <br />;:;�. � � -����7 C� , c��� x .0125 $ �P J�� �S� <br /> :. (contract price) -�' <br /> 2. State Surcharge. ** Add the State Building Code Division � <br /> Surcharge to each permit. �r��L . N'7 x .0005 $ � �� �� <br /> or $.50, whichever is greater (contract price) `� <br /> :� <br /> , <br /> 3. Postage and Handling (Only mail-in applications) $ 1.50 �i <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ��% . '(�' '�� <br /> � <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount chazged for the permitted <br /> work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the <br /> customer for the work done. If any material, equipment, labor, or installation are fumished by the owner, <br /> tenant or any other party the reasonable market value of such items must be added to the estimated cost <br /> or contract price for permit fee purposes. In the event that there is a dispute on the amount of the job cost, <br /> the City may 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 <br /> greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price. <br /> The undersigned hereby applies to the Ciry for issuance of a Mechanical Permit, agrees to do <br /> all work in strict accordance with the ordinances of the Ciry 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: /� � G��.�- Date: �- C—� <br /> Approved By: Date: 5 •� '�v <br /> . , . , _ _ <br /> . - , <br /> _ , _ ,,,�; <br /> � � ., <br />