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� � :� �-=�:�f --fi-- �1A � <br /> F <br /> 4L' � <br /> WOOD BURNING EQUIPMENT ` <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 /> i <br /> Brand Name Model No. <br /> ti � Mfgr's Min., Clearances, sidez , rear , min. flue dia. <br />�-�� Total <br /> VENTILATION <br /> No. Kitchen E�aust ducted recirculating cfm <br /> � No. Bath E�aust (must be ducted outside) cfm <br /> � �T�, !J4}le� F;rg: T nrntinnc rfm <br />` TOtal <br /> •.�� <br /> ;�_ <br /> �� <br /> '� FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> � . <br /> � Installation Removal <br /> � Fuel oil: gallons underground inside outside <br />�j:,;� LP Gas: gallons <br />°"�� x Other Natural Gas - reconnect Gas opening <br />� � PERMIT FEE CALCULATION <br /> a 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br />' � <br /> $1 ,400.00 X 1.25 � 35.00 <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> � : Surcharge to each permit. � ,4 0 0.o o x .0005 $ .�o <br />,#; i (contract price) <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 <br />��- ; 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 3�.z o <br /> gr� <br />�. <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> work including materials, labor, nrofit, and other fixed costs. It is the amount to be chazged 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 /> ** 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 11 statements made on this application are complete, true <br /> and correct. ' l , <br /> / <br /> ` Applicant's Signature: /� Date: 2-�2-93 <br />� � <br /> � Approved By: . Date: �-/� � 3 <br /> , °. <br /> �� � :..� � . � <br />