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WOOD BURNIN E <br /> Wood stove with flue <br /> Wood combination or add-on <br /> 5 Factory fireplace with flue — � C�� 3 � <br /> Factory Fireplace (s) Freestanding �nry <br /> Wood Stove (s) Franklin, other <br /> Brand Name Model No. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> VENTILIiTIaN <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <br /> FUEL STOFtAGE (MUST �E 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) S �, ✓� <br /> 7UGU, O� x .0125 $ <br /> �COttir�rt ltrlr_P� <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ j- f 5 O <br /> or $.50, whichever is greater (contrac[ price) <br /> 3. Posta e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ��� � 5 U <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 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 />� <br /> F",'' <br />�':` ** The S'fATE SURCHARGE is .0005 of [he 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 /> E'�' The undersigned hereby a�pli�s to the City for issuance of a Mechanical Permit, agrees to do <br />� all work in strict accurc".ance with the ordinances of the City and the regulations of the Minnesota <br /> State Building Code, and certifies that all statements made on this application are complete, true <br /> and correct. <br /> ' nature: � � � Date: <br /> Applicant s Sig <br /> Approved By: Date: <br /> . � � , - � � . � . - . .r <br /> ' . ' . . � .. . � � . . , ., - : �. , . <br /> . <br /> _ <br /> , ..� . . � � . . . <br /> } . <br /> , . .� . � . . . . . . . <br /> _ , <br /> . <br /> :.. ��.� ^..� . - <br /> � ..;�.,�' ��� � .. ,. '�. �.. �_.... ... :,... .,. .. -�� �_.._. . ._. �. . . . ..,. <br /> _..�...._ .0 ... _ . �.. ...` Y♦ .. __ ` ,_ „�...�.._s, _ . . �..vw�,u' <br />