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�� <br /> �� .��, � <br /> 5 L-�-� 1�.� � � <br /> � <br /> u � �" <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 4` <br /> Wood Stove (s) Franklin, other <br /> Brand Name Model No. _ : <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. R�;� <br /> Total � <br /> � <br /> VENTILATION � <br /> No. Kitchen Exhaust ducted recirculating �_ cfm � <br /> No. Bath Exhaust (must be ducted outside) cfm � <br /> �,To. Ot��er Fans: I.ocatians �f� �� <br /> Total � <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) :`� <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside ��;� <br /> LP Gas: gallons �` <br /> '� <br /> Other Gas opening �;� <br /> � <br /> PERMIT FEE CALCULATION `� <br /> 1. L25% of Contract Price* or Minimum Fee ($35.00) � <br /> x .0125 $ �5�� � <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. �Zs �, x .0005 $ � <br /> (contract price) § <br /> or $.50, whichever is greater <br /> 3. Posta�e and Handlin� (Only mail-in applications j $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ _�'�f , �� f <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted � <br /> 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 fumished 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 pemut 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 /> �; <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 /> � <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 state ts made on this application are complete, true <br /> and correct. � ��� <br /> Date: l ��—� � <br /> Applicant's Signature: - <br /> Date: � <br /> Approved By: � <br /> ;�, <br /> ._ . _ .�,.. . ,_-, . , � : _ . s. _...�.e.,�.�.:,R�... <br /> s:- <br />