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1 <br /> WOOD BURNING EQUIPMENT <br /> �Vood 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 /> Brand Name Model No. <br /> Mfgr's Min., Clearances, side , rear , mi.n. flue dia. <br /> Total <br /> VENTILATION <br />. No. Kitchen Exhaust ducted recirculating cfin <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Qther Fa�s: I.,c�ztio:,� cfm <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 /> Other Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) ���`� <br /> �(�7"� x .0125 $ U <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Buil ing Code Division � <br /> Surchai•ge to each permit. 7 x .0005 $ � ° <br /> (contract price) <br /> or $.50, whichever is greater <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERNIIT FEE (Add lines 1-3 above) $ � � - <br /> * CONTItACT PRICE or JOB COST means ttie actual or estimated dollaz amount charged for tne pemiitted <br /> work including materials, labor, profit, and other fued costs. It is ihe amount to be charged 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[here is a dispute on the amount of the job cost, <br /> the Ciry 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�-iry for i ce o echanical Permit, agrees to do <br /> all work in strict accordance ,i���ord' s o�;the Ci regulations of the Minnesota <br /> State Building Code, and ' es a tateme de on 's a plication are complete, true <br /> and correct. �.___� _- --' <br /> , ` t����.� <br /> Applicant sSi <br /> Approved By: Date: <br />