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. • , <br /> . �� „ . , . <br /> . , <br /> WOOD BURNING EOL���v'r , <br /> Wood stove with flue � <br /> Wood combination or add-on <br /> Factory fireplace with flue <br /> � Factory Fireplace (s) Freestanding Masonry <br /> . Wood SWve (s) Franklin, other � <br /> Brand Name Model No. <br /> M,fgr's Min., Clearac�ces, side , rear , min. flue dia. <br /> _______, <br /> �NTILATION <br /> No. Kitchen Exhaust ducted recirculating � �� <br /> No. Bath Exhaust (must be ducted outside) �� <br /> _� __ _ _ No.- 4ther Fans: Locations -- - - �� <br /> �L 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 CALCUL.ATION <br /> 1. 1.25% of Contract Price* or Minimum Fee l$35.001 <br /> �/3. 73S . x .0125 $ _1, �-/�.1. (�9_ <br /> (contract price) <br /> � 2. . �tate S}�rcharge. ��qdd the State Building Code Division <br /> Surcharge to each permit. x .0005 $ _ ��,.8 7 <br /> or $.S0, whichever is greater (contract price) , <br /> 3. Posta¢e and H ndling (p�y �a�-� applications) $ _ 1 50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ,�,,��n, �� <br /> '� CONTRACT pRICE or JOB COST�ans the actual or estimated dollar amount charged for the permitted <br /> work including materials, labor� profit� and other fixed costs. It is the aznount to be charged to the <br /> ;-_--�L;,- _.�.___��r for the work done. � If any material� equip�nc, labor�or installation are furnished by the owner, <br /> tenant or any other parry the reasonable market value of such items must be added to the estimated cost <br /> or contract price for permit fce purposes. In the event that there is a dispute on the amount of the job cost, <br /> She 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 Deputment of Inspectional Services for th�price. <br /> The undersigned hereby applies to the City for issuan�e of a Mechanical Pemut, agrees to do <br /> all work in strict accordance with the ordinances of the City and the regulations of the Minnesota <br /> State Buildi�g Code, anci certifies that all statements made on this applicadon are complete, true <br /> aad con�ct. - <br /> Applicant's Signature: Date: �`y"�� <br /> proved By: � Date: a�1 S <br /> � <br /> �/ �, �7 3 s.� <br /> >� , .... .�.:�y��.u.w�.;.�;�� <br />