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ts . . <br /> WOOD BURNING EQUIPNiENT <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 /> Total <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. �3 Bath Exhaust (must be ducted outside) /�� cfm <br /> Na. Other Fans: Lc�cationc cfm <br /> Total <br /> FUEL STORAGE (MUST BE APPitOVED 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 ($35.001 _ <br /> `7��c�v — x 1.25 $ �C�� <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. `7 z ���� x .0005 $ 3 c� u <br /> (contract price) <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add line� 1-3 above) $ �S� /�� <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 chazged 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 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 .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 Ciry 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 /> ^ ` <br /> ApplicanYs Signature: � , (, '— Date: - ��- � � <br /> Approved By: � � Date: "��`�� <br /> 0 P.c+. c9tS s P.v�. <br />