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�y <br /> � <br /> �� ' :�7 <br />��� � <br />��x <br />�� WOOD BURNING EQUIPMENT <br />;�' � <br />�l� Wood stove with flue � <br /> Wood combination or add-on <br /> F'. <br /> ; Factory fireplace with flue <br /> s: <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 />� _ <br />� V�NTILATION <br />�� No. Kitchen Exhaust ducted recirculating cfm <br />� No. Bath Exhaust (must be duc ed outside) , cfm <br /> , No. Other . � ' ns ��� f,��27� �/%2 cfm <br />� Sd�Lt9 aDOa �� <br />�; FUEL STORAGE (MUST RE APPROVED BY FIRE MARSHAL) �-� <br />� � <br />�; Installation Removal ` <br /> 3: <br /> f. Fuel oil: gallons underground inside outside <br /> LP Gas: gallons � <br />'' Other Gas opemng � <br /> � <br /> PERMIT FEE CALCULATION '�� <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br />� �7�� �' x .o12s � .35�00 � <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division �3 <br /> Surcharge to each permit. x .0005 $ /, 35 � <br /> or $.50, whichever is greater (contract price) � <br /> � <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 �; <br /> S3 <br /> 4. TOTAL PERMIT PEE (Add lines 1-3 above) $ 3 7 �5 _ xs <br /> � <br /> k <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 chazged to the � <br /> customer for the work done. If any material, equipment, labor, or installation are furnished by the owner, � <br /> �a� <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'CATE 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 appl i�;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 o�the Minnesota :� <br /> State Building Code, and cert'fies that all statements made on this application are complete, true <br /> and correct. <br /> Applicant's Signature: , Date // � 9�, r� <br /> Approved By: Date: <br /> <.' � , �' "�� <br /> ., <br /> - , <br /> � <br /> ���=_.r�b ,���.r,..,._ � , _ ._.r.. �� . T . . . .. ,,- _ _.. .d r-� <br />