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_ \ � <br /> � <br /> 't <br /> �y�� <br /> <fi. <br /> ti WOOD BURNING EQUIPMENT <br /> Woc�d 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 /> Total <br /> VENTILATION <br /> No. Kitchen Lxhaust ducteu :ecircu?ating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <br /> Total <br /> FUE TORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> �'uel oil: gallons underground inside outside <br /> � Gas: gallons <br /> —✓ Other 1'LGL,�-✓�t.-� QS � Gas opening �'D -�jr��IuCES. <br /> PERMIT FEE CALCULATION <br /> 1. 1.25%o of Contract Price* or Minimum Fee 35.a0 �� � <br /> d(� x .0125 $ <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division C Q <br /> Surcharge to each permit. �� lQo� x .0005 $ o <br /> (contract price) <br /> or $.50, whichever is greater <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> � TnTnr pFRMIT FEE (Add lines 1-3 above) $ <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, 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 pemut 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 cali 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 conect. <br /> �Applicant's Signature: Date: � � � � <br />��: <br /> Approved By: Date: <br />+'�' <br />;q,•, <br />