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—. <br /> . t � +� <br /> ` <br /> _. �. '��, ." <br /> �,:.:y 't ...a .. <br /> � .a .; . - � . . . .. � � �- <br /> IA� <br /> WOOD BURNING EOUIPMENT <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 /> �;. <br /> ,, <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 /> '7 <br /> �t FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br />�.-�� Installation Removal <br />�, <br /> '' Fuel oil: gallons underground inside outside �� <br /> y� LP Gas: gallons �' <br /> � <br /> Other Gas opening �` <br /> r� <br /> t. <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> - ��l�: v'�a x .0125 $ �--A`3 I�.��� <br />'.`;, (contract price) :. <br /> 2. State Surcharge. ** Add the State Building Code Division �. " <br /> {' Surcharge to each permit. ���.v`� x .0005 $ / -�-� <br /> �' or $.50, whichever is greater (contract price) <br /> Y�` 3. Postage and Handling (Only mail-in applications) $ —�--- <br />��=: 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �► .�-�C.�,�-�� <br /> ru'.� * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br />�' <br />�r- 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 />� h '� ** 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 �1 state�ents made on this application are complete, true <br /> and correct. �� �'� <br /> ',� <br /> , `� � X `,�� i <br /> Applicant s Signature: �� ,�'�% Date: � �3� <br /> Approved By: Date: <br /> �� ., �� . ' . �� � � , . 4. � � � � � . �� . � � _ <br /> ...� .,� . . . �� . , � .. <br /> w. . . . . . ., . .. , ,.. . :�. '��r. � . . i': . . .. . .. . � � .,. ... � , � • .: . . {„ .� 1 � .. � <br />