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t .l � • <br /> WOOD BURNING EQUIPMENT <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 /> Total <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations �� <br /> . Total <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> � <br /> Other �., ��r� �;�� o � ` .�.� � Gas opening <br /> ,L,�s t/f�L �s a s•G�Z� . <br /> PERMIT FEE CAI,CULATION <br /> l. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> ��`��.>�.: � x .0125 $ <br /> (contrac[ price) <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ <br /> (contract price) <br /> �r $.50, whichever is greater <br /> 3. Po�ta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> work including naterials, labor, profit, and other fized costs. I[ 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 permi[fee purposes. In the event that there is a dispute on the amount of the job cost, <br /> the Ciry 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 City for issuance of a Mechanical Permit, agrees to do <br /> all work in strict accordance with the ordi.nances 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 /> A licant's Signature:c,� 2���� Date: � � � <br /> PP <br /> , <br /> Approved By: Date: <br />