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- � <br /> WOOD BURNING EOUIPMENT <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 /> Total <br /> VENTILATION <br />. No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations �� <br /> . Total <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAI.) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <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 /> Cj'�� x .0125 $ �r�� `� <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division `� <br /> Surcharge to each permit. �'� �� x .0005 $ �7 � <br /> (contract price) <br /> or $.50, whichever is greater <br /> 3. Postage and Handline (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ��.-1 � <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollaz amount charged for the permitted <br /> work including materials, labor, profit� and other fized 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 /> tha Ciry may request the submission of a signed copy of che accual conuact. <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 work in strict accordance with the ordinances of the City and the reguladons of the Minnesota <br /> State Building Code, and ce ' ies that all state ents made on this application are complete, true <br /> aad correct. . . <br /> Applicant's Si ture• Date: � <br /> Approved By: � Date: ���7—� �' <br />