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! ' � <br /> � <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 /> i 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 /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> /�G�� � G'� x .0125 $ � � • C� � <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. / �'C� , � c� x .0005 $ I� <br /> or $.50, whichever is greater (contract price) <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ��7� ,yc: L' <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 pernut 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 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 Ciry and the regulations of the Minnesota <br /> State Building Code, and certi�es that all statements made on this application are complete, true <br /> and correct. �� <br /> Applicant's Signature: �/cc�e ���'�-'�— Date: �� �a�—� 7 <br /> / � �Approved By: Date: <br /> A <br /> �� � . .:,� � . <br /> kL` j,` "� � I � , _ F � `S <br /> . <br /> .. . <br /> x ':` ., �'.,` ' ,;. �. , ._:.� ... . . .. ,y:�: <br /> -.� � . . ' � . ,..: ':_� �. . .. .. <br /> D . �. . ": ` _ _. <br /> ;.:' - .. - ,. � ��. <br /> _'S_t.as.�� ti "-�r �.�1. A.� 5l..�:�....b.w..lTu�d�.. '� ..::�.�1...��� 2.>.-:.., dC '"- . ,..Sui�.. ._ ._.. ._u.x.aau+.,u���C.�r.��:. ' im�.r �c.c.LA:L:fiY•`�c <br />