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� <br /> ti <br /> �VOOD BTJ�IING �QL�NIENT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fueplace with flue , <br /> Factory Fireplace (s) Freestantiing Masonry ._ <br /> Wood Stove (s) Franklin, other <br /> Brand Name ModellVo. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> Total <br /> �N'�"LI�A�'ION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath E�aust (must be ducted outside) cfm <br /> Na. Other Fans: Locatians cfm <br /> Total <br /> FUEI. ST���E (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 /> �E�IIT' F�E C�CUL�TIOi01 <br /> l. 1.25% of Contract Price* or IVV�ir�i�e�rn Fe� $35.Q0 <br /> �_�1�� x .0125 $ �p�� � <br /> (contraci price) <br /> 2. State Surchar�e. ** Add the State Building Code Division i <br /> Surcharge to each permit. x .0005 $ �C-�� <br /> (contract price) <br /> or $.50, whichever is greater <br /> 3. - Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ '"J� <br /> * CONTRACT PRICE or J0�COST means the actual or estimated dollar amount charged for tiie perm;tted <br /> work including materials, labor, proiit, and otlier fixed costs. It is the amount to be charged to the <br /> customer for the work done. If any material, equipment, labor, or instaliation are furnished by the owner, <br /> tenant or any other parry 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 tk�e job cost, <br /> the City may request the submission of a signed copy of the acnial contract. <br /> ** The STATE SURCHARGE is .0005 of the contract price under $I,OQ0,000 or $.50 - whichever is <br /> greater. For valuations over $1,000,000 call the Department of Inspactional Services ior the price. <br /> The undersigned hereby applies to the City foz issuance of a Mechan.ical Permit, agrees to do <br /> ali 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 /> Ap�licant's Signatur . Date: �7 a� <br /> Approved By: Date: <br />