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� <br /> . <br /> �:� <br />��,. �� �, � , � <br /> � <br /> �� <br /> WxE <br /> WOOD BURNING EQUIPMENT <br /> � <br /> 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 /> i�1,5��c�/ �' � i�c fz �.��r �5��c;;�<<= �'r�'%'��'�-e..� <br /> VENT�.ATION ��� �'=`�) � <br /> No. Kit�hen E�aust ducted recirculating cfm <br /> No. Bath E�aust (must be ducted outside) cfm <br /> No, Other Fans: Locations �� <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br />� � - LP Gas: gallons Gas o enin <br /> �� Other P g <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) C o� <br /> l;,��� `-- x .0125 $ � ���" <br />�:;:�:;, <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ - -�L' <br /> or $.50, whichever is greater (contract price) <br />�'� 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br />���° 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ -�`� =`� <br /> ,`Y:'.::.;..; <br /> }�.'"s�'.:.:..'.. <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 fumished by the owner, <br /> ;,;..�,x;- -'; 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 /> '�. <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 /> �� ; <br />��� <� ;�= greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price. <br />�Ve The undersigned hereby a�plies to the City for issuance of a Mechanical Permit, agrees to do <br />�> <br /> ;�� all work in strict accordance with the ordinances of the Ciry and the regulations of the Minnesota <br />�� State Building Code, and certifies that all s�atements made on this application are complete, true <br /> �� and correct. % <br /> , �� � <br /> , A licant's Si ature: � � �'�' � ------------ -D�te: � � <br />�� � PP � ��� � � ��--- <br /> ,,i,, -T ,�--- <br />� L Approved By: Date: <br /> t <br />�' <br />� ��~ _ � <br /> , <br />� �� -� � .: <br /> . <br /> .. <br />�: .' .- . . _.. .._. . .. . .. �___�... __ .. .� . <br /> . ..,x _ _._ � .. .� ��. ., . �- <br /> � . <br /> � <br /> __ .� -- - ._ WL�_A.. . .��, �. . ���. � �.,� <br />