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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 BE 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 /> $ 30� �' <br /> � ' \ }. * ;._�.:� x .0125 ` , `_>c �� <br /> ' (contYact price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. ,�i,��, :i,_��.���'=-'- x .0005 $ �;���� ���_� <br /> or $.50, whichever is greater (concract price) <br />�� 3. Postage and Handlin� (OYIy mail-in applications) $ 1.50 <br />�`: 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �� l�, . � ,� <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pernutted <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 fumished 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 pernut 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 /> and correct. <br /> Applicant's Signature: Date: �`� <br /> ��- � � � <br /> Approved By: <br /> � Date: �U ��' � <br />�-; <br />�; <br />�' � � s : � ;. <br /> �� q . � t ��,I f ;�r <br /> : <br /> . . ,. <br /> : .:� <br /> . � ; <br /> . ,. <br /> � <br /> � r , � �`. <br /> V�.r� ' . . . .a �<�s.,�..__.� . .... .... .s.. +zk.. <br /> - r . <br /> �, . , �� .. . ., <br /> ._ a.�.. .,__s,.� � ._ ,}.. ..Y ,..y. _�...4 . _. . .. _ _ r..��.. <br />