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� _.. . _ _ <br /> w... �...M.�: _ ._ , .. ��: , . _ �. ..:.. .. . . a._:. _ _ __ . ... . .. , ___.._... .__ .. <br /> _ __ _; _ _. _ � ._,� . ._. . :t <br /> t � ' � <br />` <br /> j. 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 Model No. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> 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%o of Contract Price* or Minimum Fee ($35.00) <br />�n:' /.S��E? x .0125 $ �r�� <br />�'" (contract price) <br /> ri <br /> ?� 2. State Surcharge. ** Add the State Building Code Division <br /> ' Surcharge to each permit. /SG�' x .0005 $ r 7� <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) $ .3�.,�7J <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pernutted <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 fumished 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 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: (�'G° Date: ����� �� <br /> Approved By: Date: <br /> , , . . <br /> . . } . , . _ x y ' <br /> , �. > <br /> ; <br /> ,. '... x, . � _ _ <br />