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w <br /> ' ' • a <br /> WOOD BURNING EQUIPMENT <br /> Wooci stove with flue <br /> Wood combination or add-on <br /> I�actory fireplace with flue <br /> Factory Fireplace (s) Freestanding Masonry <br /> Wood Stove (s) rranklin, 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. Bath Exhaust (must be ducted outside) cfm `� <br /> No. Other Fans: Locations cfm � <br /> M <br /> I'U�L STORAG� (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 /> P�RMIT r�E CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum ree 35.00 <br /> ��O�C� OL� x .0125 $ <br /> � (c/ ontract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. 'I'O"I'�1L PI?RMIT FE� (Add lines 1-3 above) $ <br /> * CONTRACT PRICE or JOB COST mcans the actual or estimated dollar amount charged for the Permittcd <br /> work including matcrials, labor, profit, and other fixed costs. It is the amount to be chargcd to the • <br /> customcr for the work done. If any tnaterial, equipment, labor, or installation are furnished by the owncr, �� <br /> tenant or any other party thc reasonable market value of such items must be added to the estimated cost � <br /> or contract price for permit fec purposes. In the event that there is a disp�te on the amount of thc job cost, �� <br /> thc City may request the submission of a signed copy of the actual contract. ;� <br /> ',, <br /> ** 'I'hc STnT� SURCIIARGE is .0005 of tlic contract pricc undcr $1,000,000 or $.50 - whichcvcr is <br /> greater. For valuations over $I,000,000 call the Departincnt of Inspectional Scrvices 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, and certifies that all statements made on this application are complete, true <br /> and correct. <br /> Applicant's Signature: � � ��^ �� � � Date: ��� — —�1� 5 <br /> Approved By: Date: <br />� � ° ' � � r i a �, <br />�:�.�,,:,'��`�.�;.���.�...c���r.° a �� '�� �' . .,�.,f� _ _. .�_ �.. �� ���u..�r__ � <br /> r:n.e...�_.�...�L .�" 3�a�.n...�,i:__ .� .x. � y.�r.:�. -.....,.w.,.s« ..,'ai <br />