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• • •� <br /> WOOD BURNING EQUIPMENT <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 /> Total <br /> VENTILATION <br /> No. Kitchen E�aust 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 /> PERNIIT FEE CALCULATI01�1 <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> _j���r�.�l, x 1.25 $ �//: .�;— <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code I��vi�ir�r�4 •�� <br /> Surcharge to each permit. ��'�K> �Z, �x=""� �x 0005' $ �.�, � _ <br /> ,.. ; <br /> (contract pric � <br /> 3. Posta�e and Handling (Onl mail-in a lica�ians � , „ $ � <br /> Y PP �,., � ' <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) ;- ;� . , $ �f:� ��� <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 mazket 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 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 Min.nesota <br /> State Building Code, and certifies that all statements made on this application are complete, true <br /> and correct. � <br /> �i <br /> Applicant's Signature: �i�,CC�. `- � Date: � ��-L <br /> Approved By: Date: <br />