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w <br /> i`: <br /> ~ `;� <br /> �:''t <br /> �f <br /> :� <br /> WOOD BURNING EQUIPMENT ;� <br /> Wood stove with flue � <br /> Wood combination or add-on ;3 <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 /> VENTILATION c��,�..P <br /> No. � Kitchen E�aust ducted recirculating cfm <br /> No. � Bath Exhaust (must be ducted outside) cfm <br /> No. _� Other Fans: Locations c��Ue� cfm <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 FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> �F��.�p x .0125 $ �ja •SO <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. q ,Q�Q .C(� x .0005 $ � . 5O <br /> or $.50, whichever is greater (contract price) <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 �� <br /> `:� <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ��'Q,�_ ';a <br /> �:�; <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> � � work induding materials, labor, profit, and other fixed costs. It is the amount to be charged to the <br /> cust�mcr.o:thc work dor.e. If any material, :,qu:pment, labcr, or insta:lat:on ar;, fu:r.ished 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 S"I'ATE 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 /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do <br /> all work in strict accurdance with the ordinances of the City and the regulations of the Minnesota <br />., <br /> State Building Code, an certifies that all state nts made on this application are complete, true <br /> ;, and correct. <br /> }'; <br /> - Applicant's Signature: � Date: 8'aa��1� <br /> t°° <br /> � Approved By: Date: �� <br /> k ,�„� <br />� .{ <br /> � � -. . .� . . . � . . ' - ' , '. . � . ' . ' . .. � Y <br /> s . . , . . . . , � , <br />� ^ � - , . , r . - .. � f� <br /> � :. <br /> i� . . .. . ' Y..� .. '. .. . . - _ :�.. .:��� 'k5 <br /> f _ i <br /> s. . ., .. i . ... . � . . , ... . . � ' r�. .. . � . . � � . � ..., lu li.. �i <br />