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� >- .� �� 7� �, � a <br /> ��� � <br /> . � � � �, � <br /> �� � _ � � � __ _ , � � � - <br /> WOOD BURNING EQUIPMENT � <br /> s 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 /> Brand Name Model No. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> ; VENTILATION <br /> } No. Kitchen Exhaust ducted recirculating cfm � <br /> ` No. Bath Exhaust (must be ducted outside) cfm °_F <br /> No. Other Fans: Locations cfm f <br /> � <br /> f <br /> 'g 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 /> ��Crt�= . ,<_ x .0125 $ `r � ��; <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ / . r�' <br /> ' or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ ..�`�' <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �y yr. <br /> * CONTRACT PRICE or JOB COST means the actual or estunated 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 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 pernut 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 all statements made on this application are complete, true <br /> and correct. <br /> ' ` -L - E�� ,/�G' .�f <br /> Applicant s Signature: � � Date: % <br /> Approved By: Date: <br /> ;, �, <br /> ' �; ; r: � _ �° <br /> � r� i � ' y <br /> ' � ����� _ � � � , �_ � � �� <br /> � � � , , _ <br /> , , . . . . _ � ,� �."_. . f , _ .:�r _ _ � . . . <br />