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. <br /> WOOD BURNING EQUIPMENT <br /> Wood stove with nue <br /> Wood combination or add-on <br /> Factory fireplace with i7ue <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 /> V�NTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Batli Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cCnl <br /> FiJ�L STORAGE (MUST �E APPROVED BY FIR� MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> PCRMIT rI;� CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> �'�7 0 _ o �:c.� x .0125 $ S: c�c� <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. __�c��r�o x .0005 $ 5��[� <br /> or $.50, whicllever is greater (concracc price) <br /> 3. I'ost�e atid I-Iandling (Only mail-in applications) $ 1.50 _ <br /> 4. "I'OTl1I, PERMIT FEE (Add lines 1-3 above) $ -�e�, S c� <br /> * COV'1'RACT PFI�E or JOB COST rrcans the actual or estimated dollar amount charged for thc permitted <br /> work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the <br /> customcr 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 pricc 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 STnTE SURC}IARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is <br /> greater. For valuations over $1,000,000 call the Deparhncnt of Inspectional Services for the price. <br /> The undersigned hereby applies to the City for issuance of a Mectlanical 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 /> Applicant's Signature: Date: /// S r f/_ <br /> Approved By: Date: <br />