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, <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 S� �7 i�d� Model No. 2 3� <br /> Mfgr's Min., Clea ances, side �, rear �' , min. flue dia. i� <br /> VENTILATION <br /> No. Kitchen Exhaust - ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <br /> FUEL STOFiAGE (MUST RE 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 `'�J x .0125 $ `j�-G�•' _ <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ /. �-� <br /> or $.50, which�ver is greater (contract price) <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ �— <br /> 4. TOTAL PERMIT PEE (Add lines 1-3 above) $ �C. �5 <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged 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 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 S"fATE 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 appl i�� to the City for issuance of a Mechanical Permit, agrees to do <br /> all work in strict accurc!ance with the ordinances of the City and the regulations of the Minnesota <br /> State Building Code, and certifie that all statements made on this application are complete, true <br /> and correct. r-- <br /> Applicant's Signature:' - Date: � 2'2��C� <br /> � <br /> Approved By: Date: <br />