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� . � <br /> . -:. . . . . --- <br /> WOOD BURNING EQUIPMENT - <br /> Wood stove with flue . � <br /> _ 'p�Tood 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 /> To#al <br /> VENTILATION <br /> No. _� Kitchen Exhaust ducted recirculating ��, c� <br /> No. �_ Bath Exhaust (must be ducted outside) �� <br /> No. �_ Other Fans: Locations �� c� . <br /> . Total _.._ <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground i.nside outside <br /> L,p Gas: gallons <br /> Other Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price�` or 1Vlinirx�um Fee ��$��-�d�x .0125 $ � �� •�� <br /> �(contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each pemut. �� �a'S .Q�— x .�5 $ � •�� <br /> oc ntract price) <br /> or $.50, whichever is greater 1.50 <br /> 3. Posta�e and Handlin� (Only mail-in applications) � — <br /> 4. TOTAL PERNIIT FEE (Add lines 1-3 above) <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount cnarged for the permitted <br /> work including materials, labor, pront, and ot��: �� cests. It is the amount to be charged to the <br /> customer for the work done. If any ma�enal, eQwPment, 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 /> ** The STATE SURCHARGE is .0005 of the contract price under 51,000,000 or $.50 - whichever is <br /> greater. For valuations over $1,000,000 ca11 the DePar�ent of Inspectional $ervices 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 reguiations of the Minnesota <br /> State Building Code, and certifies that all statements made on this application are complete, true <br /> � and correct.___ �..._. __ . . <br /> ,.._ _ . __ _.. . ... .�.::.. <br /> _ .. �._�.__.�::,:. � Date: � <br /> _ Applicant's Signature: <br /> " Date: <br /> APProved By:, �.: . <br />