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�'+.xti.. ..,.----�"-.., ._." : ... .. ._.q., _ .. . . '�R "`ffi. 4 �`^Tr{it <br /> � �� .� . T C�a�'``�.SF, <br /> �`�, <br /> � � <br /> .-a <br /> � ^ � � � <br /> U "' WOOD BURNING EQUIPMENT � <br />` �'��` Wood stove with flue <br /> r u�:. <br /> Wood combination or add-on <br /> ,� ��� Factory fireplace with flue <br /> ,x,���: Factory Fireplace (s) Freestanding Masonry <br /> �4` � Wood Stove (s) Franklin, other <br />�p Brand Name Model No. <br /> ��r�` Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> ,�;, <br />,�;�;.;.,,,; VENTILATION <br /> No. Kitchen Exl�aust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> � F' No. Other Fans: Locations cfm <br /> � � <br /> � <br /> FUEL STORAGE (MUST l6E 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 /> >>��c�� X .oi2s $ �'3�� <br />�:� -' (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. � �C�c'�%' x .0005 $ <�`� <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ��� � �`� <br /> * CONTRACT PRICE or,TOB 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 permit 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 call the Department of Inspectional 5ervices for the price. <br /> The undersigned hereby appli�s to the City for issuance of a Mechanical Permit, agrees to do <br /> 4� all work in strict accor�ance 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 Date: Cj- �'�t(y <br /> Approved By: Date: <br />� ��� � � , .�� � � : . :�,�? <br />�� <br />��::< � <br />