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y <br />� <br /> t <br />,�. <br />,, <br />�:: <br /> WOOD I3URNING EQUIPMCNT <br /> Wood stove with flue <br />�� Wood combination or add-on <br />� <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 /> x <br /> a <br />�� V�NTILATION <br />� No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> k No. Other Fans: Locations cfm <br />� RAGE MUST �� APPROVED BY FIRE MARSHAL) <br />� FU�L STO ( <br />° Installation Removal <br />��� Fuel oiL• gallons underground inside outside <br />�V LP Gas: gallons <br />� <br />�, Other Gas opening <br />� <br />� P�RMIT FEE CALCULATION <br />� 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br />�, �`9y vU x .0125 $ S 5. Uz� <br />� (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. �a o x .0005 $ �.a-U <br />,. <br /> or $.50, whichever is greater (con�ract price) <br />� <br />� 3. Yosta�e and Handliil� (Only mail-in applications) $ _�� — <br />„� 4. TOT�1L P�RMIT FEE (Add lines 1-3 above) $ S 7• � <br />�� * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br />�' work induding materials, labor, profi[, and other fixed costs. It is the amoun[ to be charged to [he <br /> customcr for the work done. If any material, equipment, labor, or installation are furnished by tlle owner, <br /> tenant or any other party the reasonable market value of such items must be added to the estimated cost <br /> Q: or contract pricc for permit fce purposes. 1n the event that there is a dispute on the amount of the job cost, <br />� , the City may requcst the submission of a signed copy of the actual contract. <br /> ** The STnTr SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is <br /> greatcr. For valuations over $1,000,000 call the DeParhnent of Inspectional Services for thc price. <br />� The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do <br /> t, <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 t 's application are complete, true <br /> and correct. <br />� <br />� Applicant'sSignature: ` Date: O l S�` <br />�, <br /> i'� � r �I <br /> Approved By: Date:� L.l <br />� � <br />�' ;' <br />��� � <br /> i' _ .�: , �� .. �. . .,. .�.�.��,_..�s�_..,�.m,��� <br /> t.t: , �:.. � ._: . -:.. �. : ���_... <br />