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, - t . <br />�'' WOOD BURNING E�QUIPMENT <br />,,,. <br /> Wood stove with flue - <br /> Wood combination or add-on <br /> Factory fireplace with flue r � <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 /> VENTII,ATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <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 /> _ ���s" - X .oi2s $ "lD,i� <br /> (contract 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. TOTAL PERMIT FEE (Add lines 1-3 above) $ '7�,!��� - <br /> ,� .. <br /> 'r` * 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 aze fumished by the owner, <br /> tenant or any other party the reasonable market value of such items must be added to the estimated cost �;;i <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 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 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: j Date: l0 ' �'S <br /> Approved By: � Date: /v-t 9 -5'S <br /> , <br /> � � . <br /> , _ , <br /> , , �e,� .�, , <br /> _ ., _ <br /> � .... , . . ,��. ._.4 <br />