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' � � <br /> � <br /> WOOD BURNING EQUIPMENT r <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Pactory 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 /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfin <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfin <br /> rU�L STORAGE (MUST BE APPROVED BY F1RE Mt1RSHAL) <br /> ��' Installation � Removal <br /> t> 'C. Fuel oil: . ;.;;i gallons �'` underground inside outside <br /> LP Gas: gallons <br /> ,, � Other �-,:�+ir`'c_ _ ;� ' ',� �;�� � ;,"'; ,; Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25%o of Contract Price* or Minimum Fee ($35.00) <br /> �; �. , '��Cc x .0125 $ <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ <br /> or $.50, whicliever is greater (contract price) <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 _ <br /> 4. TOTAL PCRMIT FE� (�1dd lines 1-3 ahove) $ <br /> * CONTRACT PRICE or JOB COST mcans thc actual or estimatcd dollar amount chargcd for thc Pcrmittcci <br /> work including materials, labor, profit, and othcr fixed costs. It is the amount to be charged to thc <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 ttiere 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 /> ** Thc STnTE SURCHARGE is .0005 of thc contract pricc under $1,000,000 or $.50 - whichcvcr is <br /> grcatcr. For valuations over $1,000,000 call tl�e Department of Inspectional Scrvices for the pricc. <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 /> A licant's Signature: \�� ��' �;;� --.-._.___ Date: �� l � �"�� <br /> PP <br /> Approved By: Date: <br />