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x .;,�'a^n �'.. <br /> .� � <br /> 4 <br /> WOOD BURNING EOUIPMENT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue <br /> � Factory Fireplace (s) Freestanding Masonry <br /> f 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 E�aust 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 />�`n Installation Removal <br /> � Fuel oil: �O> gallons underground inside outside <br />�' LP Gas; gallons <br />�,�. <br /> Other Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> x .0125 $ <br />``"` (contract price) <br />�, 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ <br />,.*,. <br /> or $.50, whichever is greater (contract price) <br />� 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br />"",j 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ <br /> z��` * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount chazged for the permitted <br />��,: <br /> a 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 furnished 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 pernut 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 /> i�� <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 /> 4 .. <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do <br /> " all 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 /> ' �j � O <br /> Applicant's Signature• �i-���-- ���-� Date: f � � � ' � <br />'`;:'e <br /> s.,; <br /> Approved By: Date: <br /> _ . , . : . <br /> . <br /> ✓ J..�:.�. . . .. ` , . .. . 1�. . .�' �� , , '. .. . . .. ..��.. . . � .. � . ' /� . ... . ..�... . .. .. . :.:� .. <br />