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t... <br /> ��- �. , <br /> �. , y -- ,. � <br /> "'- ` <br /> . <br /> >" � ;c _ <br /> ,��,: <br /> , <br /> WOOD BURNING EOUIPMENT �`� <br /> Wood stove with flue <br /> - Wood combination or add-on ' <br /> Factory fireplace with flue <br /> • Factory Fireplace (s) Freestanding Masonry � <br /> � �., WoQd Stove (s) Franklin, other <br /> �- : � Brand Name Model No. � <br /> ;�; <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> VENTILATION � , <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <br /> r'UEI. S�'Ot�' GE (MUST BE �Pt RO v�D BY FIt-2E MARSHAi,) <br />- Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br />; - <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> ` � � g� .� x .o125 $ =i�.G� <br /> (contract price) <br /> f � <br /> 2. State Surchar�e. ** Add the State Building Code Division <br />��: Surcharge to each permit. x .0005 $ ,G�' <br /> %`;'' or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 .: <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ t �; <br /> 4: <br />�"�;�' * CONTRACT PRICE or JOB COST means the actual or estimated dollaz 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 /> 4��� 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 riarket value of such items r.zust 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 />;, � - f; <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 /> . ; <br /> and conect. � <br /> � <br /> � Applicant's Signature: � Date: <br /> Approved By: Date: `7- l 1 � (�� <br /> �; � <br /> :r - : < <br /> . : <br /> . <br /> , . . <br /> , , <br /> r� _ �, i� � � � ,.:. <br /> � s ` <br /> 1 , • . � -. � <br />