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� <br /> � t <br /> t <br /> . � <br /> WOOD BURNING EQUIPMENT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue F; <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 IMUST BE APPROVED BY FIRE MARSHAL) =: <br /> Installation Removal <br /> Fuel oil: �allons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening � <br /> �� <br /> PERMIT FEE CALCULATION �� <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) � _ � <br /> ��G� , �' x .0125 $ �'� CC ..._. � _ `� <br /> (contract price) __ _.,,p <br /> 2. State SurcharQe. ** Add the State Building Code Division /R .,� � <br /> Surcharge to each permit. 1 ��iL-�' x .0005 $ � lS�� � <br /> or $.50, whichever is greater (contract price) �� <br /> ;# <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ � 1 50 �� <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �)� • �� :� <br /> * CONTRACT PRICE or JUB COST means tne actual or estimat�d 3ollar amount charged for the�ermitted � <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 pennit fee purposes. In;he event that there is a dispute on the amount of the job cast, <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 undersi�ned 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 /> `' ' /�� I:.�C�� ':� <br /> Arrlicant's Signature: � <br /> '��� � ��G � r�o� Date: � <br /> Approved By: Date: <br /> � � 1 <br />