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N--- <br />� � � <br />��, <br />�. <br /> WOOD BURIVING 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 /> Mfb's Min., Clearances, side , rear , min. flue dia. <br /> :;� <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 /> 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 /> � <br /> PERMIT F'EE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($3�.00) <br /> �; o�r� x .0125 $ � �, J�C� <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. �. ��u x .0005 $ � . � Q <br /> or $.50, whichever is greater (contract price) <br /> 3. PostaQe and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ (� (�, 5`O <br /> * CONTRA�T PRICE cr JOB COST means the acblal or estimated dollar amount charged for the permitted <br /> work including materials, labor, profi[, 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 aze 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 /> ** The STATE SURCHARGE is .000� of the contract price under �a1,000,000 or 5.50 - whichever is <br /> ereater. For valuations over �1,000,000 call the Department of Inspectional Services for the price. <br /> The undersigned hereby applies to the Ciry 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 Mi.nnesota <br /> State Building Code, and certifies that all statements m this application are complete, true <br /> and correct. <br /> . , <br /> Applicant's Sianature: " . � Date: (�-(� �-9(o <br /> Approved By: Date: —�� �7 <br />