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- ' � . � . - <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 Model No. <br /> Mfgr's Mi.n., Clearances, side , rear , min. flue dia. � <br /> Total <br /> VENTILATION <br /> No, Kitchen Exhaust ducteci recirculating cfm <br /> No. Bath E�aust (must be ducted outside) cfm <br /> No. Other Fans: Locations �� � <br /> . Total <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground i.nside outside <br /> L,p Gas: gallons <br /> Other Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.001 <br /> � �O0°o x .0125 $ <br /> -(ntract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. x .Q005 $ <br /> (contract price) <br /> � or $.50, whichever is greater <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERNIIT FEE (Add lines 1-3 above) � <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 fized cosu. 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 parry che reasonable market value of such items mnst be added [o 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 c��• <br /> ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or �.50 - whichever is <br /> greater. For valuations over $1,000,00� call the DePartment of Inspectional $ervices 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 Ciry and the regulations of the Minnesota <br /> State Building Code, and rtifies that all tateme ts made on this application are complete, true <br /> � I <br /> and correct �— -- � <br /> : .._ - _---., __ Date: �`i I�1 <br /> _ Appl�cant's Signature: <br /> . _ Date: <br /> APProvedBy:-.', - , <br />