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. � <br /> WOOD BURNIllTG E UIPivIENT <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, sid� , rear , min. flue dia. <br /> Total <br /> VENTILATION <br /> No. Kitchen E�aust ducted r��circulating cfm <br /> lvo. iiaiii i�ui��ust �ii�u:[ n� .i��cit:; v;.t.�;�::j �:;i,ii <br /> No. Other Fans: Locations cfm <br /> Total <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 CALCULATIQN <br /> 1. 1.25% of Contract Price* or Minimum Fee 35.00 <br /> . t�. �t., �._ � .��, , x 1.2���-�,� $ i E-• i_ <br /> � �. , <br /> (contract price) %� �� � <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. �! ; (;:� � = x .0005 $ 1 � �J ��'� <br /> (contract price) <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ `�� , '`���.F` <br /> , <br /> * CO?�'�RACT PRICE or.ip�i rpST means the actual or estimated �ollar ame�mt r,harged fe�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 permit 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 .00OS of the contract price under $1,000,000 or $.50 - whichever is <br /> greater. For valuations over $I,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 /> ali work in strict accordance with the ordinances of the City and the regulations of the Minnesota <br /> State Building Code, cenifies that all st�itements made on this application are complete, tive <br /> and correct. � <br /> `�� . <br /> � <br /> _7 (i _,+ <br /> Applicant'sSignatur ; ' \� '` `: i '� � l L�.� �`j <br /> a 1� Date: <br /> Approved By: - Date: � a�o �� <br />