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_, . ;, ,; <br /> ; , . <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 /> VENTILATION <br /> No. Kitchen E�chaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations 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 /> ��-( .\'�'. ': <_- x .0125 $ �3,�� <br /> (contract price) <br /> _ 2. State Surchar�e. *" Add the State Building Code Division <br /> Surcharge to each permit. 3���;�'.f t x .0005 $ 1 �`� <br /> or $.50, whichever is greater (contract price) �;° <br /> _ �' ; <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 � _;ff <br />:; 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �--( �C: < :�'� az°; ti t' <br />� ,., <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> ; t , <br />, • work including materials; labor, profit, and other fixed costs. It is the amount to be charged to the <br /> cusiomcr fur iric work d�ne. Ir"any r.ateri�:i, equipmecii, labor, or ir,�ialiation are �riiished by the owne�, ' ' <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 /> ** 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 Minnesota <br /> State Building Code, and certifies that all statements made on this application are complete, true <br /> and correct. <br /> ,p <br /> Applicant's Signature: f�'( • Date: ���- <br /> Approved By: � Date: <br /> � ; _.. ... ,. _ _. �.#�... .. . . ... .__ . ,.. � ,.., . . . ;iW. . . , . . . <br />