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WOOD BURNING EQUIPMENT <br /> Wood stove with flue <br /> -,.,i 3,.,��"'. :.:�'�-=1--,g'--- .. <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 /> Total <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 /> Total <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL)— �"u" ��'�� I <br /> � Installation Removal <br /> �ti,�sf� s������_ Fuel oil: a so gallons underground � inside outside <br /> LP Gas: gallons <br /> � <br /> �� Other Gas opening <br /> PERMIT FEE CALCULATION <br /> " 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> �� GO G x 1.25 $ 3�^ °° <br /> contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. ,z �o d x .0005 $ /- o � <br /> (contract price) <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 3 7 S'� <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> work including materiais, labor, profit, ar�d otner fixed coats. It is :�e amou�t 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 mazket 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 .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 /> 1 and correct. <br /> Applicant's Signature: ' Date: - 05 '� <br /> Approved By: �-- Date: ( <br />