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_ J _ �► ;�. <br /> WOOD BURNING EQUIPNIENT <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 Model No. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> �a <br /> VENTILATION / <br /> No. _� Kitchen E�aust V ducted recirculating cfm <br /> No. / Bath Exhaust (must be ducted outside) ��i 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 /> �vl�C�.��1u x .0125 $ �.J.���' k <br /> (centract 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) �',j' <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �(0::�1� <br />'��.; * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pernutted - <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 /> tenalit 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 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 /> , <br /> Applicant's Signature:� Date: /,���1�� <br />>�:: <br /> -i7?.G��, <br /> Approved By: Date: <br /> . <br /> � , <br /> > : � ; _ : _ <br />