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�`.�� � � <br /> k, <br />*. <br /> WOOD BURNING EQUIPMENT � <br />�`a Wood stove with flue <br />�,:r; <br />:-� Wood combination or add-on <br /> Factory fireplace with flue <br /> Factory Fireplace (s) Freestanding Masonry <br />-` Wood Stove (s) Franklin, other � <br /> a"` � <br />� <br /> Brand Name Model No. � <br /> 4 Mfgr's Min., Clearances, side , rear , min. flue dia. # <br />� w <br />� VENTILATION � � <br />� No. Kitchen Exhaust V ducted recirculatin �5p cfm �� <br />�S. <br />�` No. Bath Exhaust (must be ducted outside) �cfm <br /> No. Other Fans: Locations cfm <br /> FUEL STOFcAGE (MUST �E APPROVED BY FIRE MARSHAL) <br /> Installation Removal '� <br /> Fuel oil: gallons underground inside outside ,:� <br /> a <br /> LP Gas: gallons `s <br /> j Other � �" G - � Gas opening <br />� <br />�` PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee 35.00 <br /> 31 X .oi2s � �s3.��-- <br /> (cont act price) { <br /> 2. State Surchar� ** Add the State Building Code Division � <br /> Surcharge to each permit. �2��j j� x .0005 $ � • �� _ <br /> or $.50, which�ver is greater (contracc price) <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 _ <br /> i: 4. TOTAL PERMIT PEE (Add lines 1-3 above) $ �• �'1 : <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 />�, <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 S"fATE 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 appl i�;� to the City for issuance of a Mechanical Permit, agrees to do <br /> all work in strict accurc!ance with the ordinances of the City and the regulations o:the Minnesota <br /> State Building Code, and certifie ha�all statements e,on this application are complete, true <br /> and correct. '� ,, % <br /> �' � l, <br /> Applicant's Signature: � Date: jZ � �U <br /> Approved By: � � Date: �Z '2� -dO <br /> -; <br /> � �. � �.�� , ; � ��;�,� � � { ,_: ;� ', � .�.. ....�,. .� � <br /> _. d� .. . ._ „ �.� _�' .. , :�� . , _ _ - �t . �___�, �_ _�.6 ���y <br />