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'' � �_— , <br /> �. <br /> t" t � `�' ! <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 /> �7` VENTILATION <br /> No. Kitchen Exhaust 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 /> (',,�.`�`�� x .0125 $ <br /> (contract price) <br /> 2. State Surcharge. "X Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ <br /> or $.50, whichever is greater (contract price) <br /> ���- ��i+t� <br /> ` - 3. Posta�e and Handling (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 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 />:f= 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[here 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 Ciry 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. �,��4� ��,s��,b��c�„� <br /> Applicant's Signature: � � � '-�^-� Date: J� %z���-�� <br /> Approved By: Date: <br /> . . <br /> �� _ �� <br /> , ;. . . <br /> ; . . . : ti , . <br /> , . . , �' , �s , <br /> , .: {� . . ,. ,, ;. , <br /> . . , . , <br /> , . <br /> � . f � , � <br /> 'rs . <br />