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�^ ;�* r �.. ..�... ... �: ,{.:: <br /> t ry'.-f� .�r' .z"s. "' ' . ��� ���.� . .. _ .,.� x.. ,. . .,... ...: , .. .. - <br /> . . �.� . �. _ . <br /> � ` . ... _ . , . <br /> a � , <br /> WOOD BURNING EQUIPMENT � - Pi � �s� <br /> �F ,R�.�'�t� � A7!l15t.! .�...i *t A�.•.+1'Ya <br /> Wood stove with flue � �� ,�y;. � � y �- >� <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 /> Total <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations 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 �'EE CALCULATIOPI <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> ` � x .0125 $ ��.�� <br /> (con ract price) <br /> 2. State Surchar� ** Add the State Bui m C de Division D� <br /> Surcharge to each permit. �C��� x .0005 $ �- <br /> (contract price) <br /> or $.50, whichever is greater <br /> 3. Postage and Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �CI, � <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount chazged 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 permit fee purposes. In the event that there is a dispute on the amount of the job cost, <br /> the City may request tbe 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 /> ����� ��� <br /> Applicant's Signature: Date: �� <br /> Approved By: Date: <br />