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� <br /> R <br /> WOOD BURNING EQUIPMENT <br /> Wood stove with flue <br /> Wood combination or add-on � <br /> Factory fireplace with flue � <br /> � <br /> Factory Fireplace (s) Freestanding Masonry ;� <br /> Wood Stove (s) Franklin, other >4 <br /> Brand Name <br /> Model No. � <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> Total <br /> VENTII.ATION <br /> No. Kitchen Exhaust ductecl recirculating cfm <br /> No. Bath E�ausz (riiust �e ductcri outside} cfm <br /> No. Other Fans: Locations cfm <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 /> Other Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> d . l L�. � x .0125 $ ��� � (_� <br /> (contract price) " t lj � � <br /> 2. State Surcharge. ** Add the State Building Code Division �� <br /> Surcharge to each permit. � ���� �� x .0005 $ <br /> (contract price) <br /> or $.50, whichever is greater <br /> 3. Posta�,e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ � ' � <br /> * CONTRACT PRICE or J(�B C(�S i means ihe acrual or esti�ate�i dQ??zr a�ount cha�ged 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 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 pemut 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 actuai contract. <br /> ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is <br /> greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price. <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do <br /> all work in strict accordance with the ordinances of the City and the regulations of the Minnesota <br /> State Building Code, ,certifies that all statements made on this application are complete, true <br /> and correct. � <br /> �' � Date: 1 2L� �� <br />`,,. <br /> Applicant's Signature: � ' <br /> r <br /> � . Approved By: Date: `U <br /> :p <br /> ,,y� <br /> h. <br /> 6$u. ,..�:u..a.e....a.�.-,....:. ,_.:� ... . . ..:...... �a�, • .._-.�a,�r.�: ... . . .. . . ... .. . ..,. ... .-. .. . r .�.e..... ...... ...a.�.. .......�..::._. . .: � -_..... .,.,....., u�•,:=iliYCee:.. ........ ♦� . <br />