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a <br /> WOOD BURNING �QUIPM�NT <br /> Wood stove witll flue <br /> Wood combination or add-on ' <br /> ;� <br /> Factory fireplace with flue <br /> Factory Fireplace (s) Freestanding Masonry <br /> Wood Stove (s) Franklin, other <br /> I3rand 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. Batli Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfin <br /> FU�L STORAGE (MUS'T BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Puel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> PERMIT FEE CALCULATION :;., <br /> 1. 1.25%o of Contract Price* or Minimum Fee ($35.00) . � <br /> � �'�� �. �,� x .0125 $ - - � � <br /> (contract price) `;:"s <br /> 2. State Surcharge. ** �1dd the State Building Code Division <br /> Surcharge to eactl permit. � =�'!����. ��J _ x .0005 $ '- ' � <br /> or $.50, whichever is greater (con[ract price) <br /> 3. Postage and Handlin� (Only mail-in applications) $ -�-:�4--_ <br /> 4. '('O'['/�L PT:RMIT PL;r (Add lines 1-3 ahovc) $ �. <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for tlle permitted <br /> work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the <br /> customcr for the work done. If any material, equipment, labor, or installation are furnished by the owncr, <br /> tenant or any other party the reasonable markct value of such items must be added ro die estimated cost <br /> or contract pricc for permit fee purposes. In the event that there is a dispute on the amount of the job cost, 7` <br /> the City may request the submission of a signed copy of the actual contract. <br /> ** Thc STnTE SURCFIARGG is .0005 of thc contract price t�ndcr $1,000,000 or $.50 - whichcvcr is � <br /> greatcr. For valuations over $1,000,000 call the Dcpartment of Inspectional Services Cor 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 /> �?' �_=G�IA /� <br /> /lpplicant's Signature: ���7 /d���� ��'��i Date: /d-/4 - 5 S' <br /> � <br /> Approved By: Date: <br />.�.... �t. �._rA�.:_._..�.�:,a.�.m. �u r_.�.......�,�.:.:.�. .._�.t�.:�, . .��.�.:�,., , �. .. _ �� .__.., .. �_._ "�,_�..� .«._� <br />