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� �„ � "f,'�"�'F�'�''�""�.:� �,:5�` '�,€:r..�.,,.�_ °�, �, �._ „`-�. . .. � . ... . .„_�.�. ,-�.M1 r,^,4,iS°�':,..s ;.c <br /> �' \ r '{r .:a <br /> ta <br /> ',� <br /> ! <br /> � rs <br /> f d <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 Exhaust ducted recirculating cfm <br /> No. �� Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <br /> FUEL STORAGE (MUST �3E 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 inimum Fee ($35.00) <br /> ��' x .0125 $ " � ', <br /> �' �v0 �_ � <br /> (contract price) <br /> 2. State Surchar� ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ �� �-' <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handling (Only mail-in applications) $ ��.-� <br /> 4. TOTAL PERMIT PEE (Add lines 1-3 above) $ � � �� ;��� <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 /> ** The S'fATE 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 appli�;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 /> Applicant's Signature: / � ,/' ✓`�� Date: ��Z3�� � <br /> _v Approved By: Date: f� oZ a� <br />