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- � � . � '� � . � , <br /> L J <br /> WOOD B G E UIPMENT - � <br /> od stove with flue <br /> Wo d combination or add-on <br /> Fact fireplace with flue <br /> Facto Fireplace (s) Freestanding Masonry <br /> Wood tove (s) Franklin, other <br /> Brand Name Model No. <br /> Mfgr's Min., Cl�arances, side , rear , min. flue dia. <br /> � <br /> - VENTILATION '� <br /> No. Kitch� Exhaust ducted recirculating cfm <br /> � No. Bath E' aust (must be ducted outside) cfm <br /> : No. Other F` : Locations cfm <br /> FUEL STORAGE (MUST BE . PROVED BY FIRE MARSHAL) <br /> Installation Re val <br /> Fuel oil: ga ons underground inside outside <br /> ' LP Gas: gal ns <br /> Other Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> x .0125 $ �� c� � <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division �� <br /> Surcharge to each permit. x .0005 $ S <br /> or $.50, whichever is greater (contract price) <br />- 3. Posta�e and Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 3 7, e� rJ <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 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 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 /> ;' ** 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 y�e ordinances of the City and the regulations of the Minnesota <br /> State Building Code, and certifies� at all statements made on this application are complete, true <br /> and conect. \ <br /> I R <br /> \ <br /> Applicant's Signature: (�� ` Date: � �'/ <br /> Approved By: �� Date: �2° <br /> � <br /> i ! .�� . <br />