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+ / - � <br /> -� <br /> � <br /> r <br /> a <br /> WOOD BURNING EOUIPMENT � <br /> Wood stove with flue � <br /> . �,,.�-�s��� �_�,��� <br /> = Wood combination or add-on � � <br /> �� <br />�,; _� Factory fireplace with flue ,G <br />-:r� � Factory Fireplace (s) Freestanding Masonry � <br /> Wood Stove (s) Franklin, other � <br />�r Brand Name ����7t Y � �� Model No. � ,`�� -L,-� � <br /> Mfgr's Min., Clearances, side �; , rear --(;- , min. flue dia. )� <br />' . � <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 /> � <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) � <br />" Installation Removal <br />' Fuel oil: allons under round inside outside � <br /> g g <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 /> I i��.,:�� x .0125 $ ,�J �(_`.�.� <br /> (contract price) <br /> � 2. State Surcharge. ** Add the State Building Code Division � <br /> Surcharge to each permit. x .0005 $ -FjU ^� <br /> } <br /> or $.50, whichever is greater (contract price) � <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 � <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ���j �G� <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, 11bor, 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 pernut fee puiposes. 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 wark 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: � �t,U��� ���� Date: �1 �`� <br /> � <br /> ;k <br /> Approved By: Date: <br />� � s`ki� ;.� �c+r rc '� . � '3 �;z, ' t 4`„3„a ti`y�"' <br />.� . ._...., ,a i.��... �,�,.a.:.��..._�'� ...,y. .>a.k.r..m�.�k�� ryi'Fr. .;.,_ .r . .._ , �.,� r_ ��.�4Y�u'� .. . . �.�r fr.: ,�f �`s�. .� _ �,t�.'_...� �-�...y�""t^_ <br />