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. � � <br /> s`� <br /> ;� <br /> � <br /> :�� <br /> WOOD BURNING EQUIPMElVT � <br /> Wood stove with flue � <br /> � <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 /> Total <br /> ..; <br /> �i <br /> VENTILATION � <br /> No. Kitchen Exhaust ducted recirculating cfm � <br /> No. Bath E�aust (must be ducted outside) cfm <br /> cfm `'� <br /> No. Other Fans: Locations ,,, <br /> Totai -_ <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> �� <br /> :�Installation Removal z <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* or Minim�m Fee ($35.00) <br /> �-� Dpp . OQ x .0125 $ (� � . �� <br /> (contract price) � <br /> 2. State Surchar� ** Add the State Building Code Division � <br /> Surcharge to each permit. $��D . C�C� x .0005 $ o'?. �� ;ti <br /> (contract price) � <br /> or $.50, whichever is greater "� <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 � <br />�k. ` <br />€�, 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ C�Co• �d <br />�,�, '.:� <br />�iry <br /> '��`' � C�ti`�'icACT P�ICE or JJS COST.:.e�s tt:e ac:ual or Pstimated dollar a�ount charged for the permitted � <br />��� work inciuding materials, labor, profit, and other fixed costs. It is the amount to be charged to the <br /> F;., � <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 />� ��� <br /> � <br /> c�` The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do � <br />�'' all work in strict accordance with the ardinances of the City and the regulations of the Minnesota � <br /> ��x State Building Code, and certifies that all statements made on this application are complete, true ;� <br /> a�, �' <br /> � and conect. . <br /> ��� <br /> �5 � Date: � <br /> �_ Applicant's Signatur . � <br /> rr <br /> �. � ; <br /> ��' <br /> Approved By: Date: � <br />