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�x-�--- :--` .�.�._`R.a'I,� — — <br />� <br /> x , <br />� : <br />� „ ,_ � <br />�'' <br />�: <br /> r' ; 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 />�, <br /> Brand Name Model No. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br />� <br /> Total <br />� <br />�� ''` VENTILATION <br />».; <br /> No. Kitchen EJchaust ducted recirculating cfm <br />�.��..f i,. <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <br /> '� �r�,`1 C`(�(,1,� �-� �/l.(� �'�1�"l I(�.�?✓�� (�,l�l G�,"J�`J(��, otal <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br />� Fuel oil: gallons underground inside outside <br />� allons <br /> r; LP Gas: g <br />� Gas o enin <br />¢ _� Other P g <br /> y PERMIT FEE CALCULATION <br />" � 1. 1.25% of Contract Price�` or Minimum Fee (�3�.00) <br /> ���; x .0125 $ �7. <br />� (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division �1 <br /> Surcharge to each permit. ?j�� x .0005 $ �• JU <br /> (contract price) <br /> ; or $.50, whichever is greater <br /> 4� 3. Posta�e and HandlinQ (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �•� <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount chazged for the permitted <br />= work inctuding 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 /> 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 the submission of a signed copy of the actual contract. <br /> ** The STATE SURCHARGE is .0005 of the contract price under $1,OQ0,000 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 />�; <br /> all work in strict accordance with the ordinances of the City and the regulations of the Muinesota <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 />�` <br />