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b� � � <br /> 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 E�aust 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 /> . <br />�;;� PERMIT FEE CALCULATION <br /> ' 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> ', t� �C�Cj.C;�C� x .0125 $ .S L,,�_ <br /> ;i <br />;; (contract price) <br /> � 2. State Surchar�e. ** Add the State Building Code Division � <br /> f�; Surcharge to each permit. �j'��G�' �j�a x .0005 $ v� � ,� J <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 />;.: <br /> ,, <br /> � * CONTRACT PRICE or JOB COST means the actual or estunated dollaz amount charged for the permitted <br />;:;; <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 />�w tenant or any other party the reasonable market value of such items must be added to the estimated cost <br /> �f `' " . 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 />�� '\ <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 Dep��tment of Inspectional Services for the price. <br />�:� The undersigned hereby applies to the City far 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 /> (� �� � I <br /> � �� / � <br /> Applicant's Signature: f_J�� ��� G , Date: <br /> Approved By: Date: <br /> ; : <br /> °' � z � . <br /> _ . � �� . . <br />