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�b!F , s ..�� eac, �-x�� "$�i�s���j I ' �' "� '�„r rn +��" �"�r�;' '`f"_- `�r , px 'j�p�' , <br /> Y v:; � �� :�� '� � r a r�y� $�R .. . . �� <br />�;j' '{` J,h�`{ ". '��' .r' t - � <br />��� ( ,.. .) r.?�� F }S< ( �i . . . ' �a, • ' � �Cy <br />.� . . . ♦ .. ; , .. . , �. <br /> .� <br /> � <br /> :i <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 STOI'rAGE (MUST �E 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 Minimum Fee ($35.00) :� <br /> G�'C�� ��=' X .�125 $ <br /> contract price) ` <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ <br /> or $.50, which�ver is greater (contract price) <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> iI 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 /> ** 'I'ATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is <br /> The S <br /> greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price. <br /> The undersigned hereby appli,;� 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 c rtifies that all statements made on this application are complete, true <br /> and correct. <br /> Applicant's Signature• �— Date: �� <br /> Approved By: i Date: <br /> � � <br /> , <br /> , : .> <br /> , <br /> ��.�.:: . : � .�...,..�.: _ _�__ . _�..�,_d _._�.v._.�,..� <br /> � <br /> � ,. <br /> W�. ,uz_F �r _��, .:..�.. z:�. ._.a� .,��_ _ <br /> ,: <br />