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� �� �� �� . <br /> � � <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 4•{-�1 Model No. �..�r 5'�., � � <br />�:F Mfgr's Min., Clearances, side �?Z_, rear ;'j , min. flue dia. ,� �� <br />�; <br />�. VENTILATION <br />``'`` No. Kitchen E�aust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations �� <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br />;`;;:; <br /> Installation Removal <br />�:;� <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 />��` ��? cZ�z� x .0125 $ <br />�'' — <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> k Surcharge to each permit. x .0005 $ <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 /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount chazged 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 pernu[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 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 correct. 1 <br /> , - , � --� `- �l� <br />` Arrlicant's Signature: ��� �___ Date: , <br /> Approved By: Date: <br />�, <br />�4e;; , . . , � . <br /> jj � ... . c ' . . . - � - � � .. <br /> � i�:. `ii.� .. ' . �, � � .� � . � � . . . . \ . , <br /> 11 <br /> .- „.._ .... . . . 'a':� . .,f�; . .,. . . . . � . . .. .. . .. . � . . . . . . . -.. � .. , � . . . . ... <br />