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�r�M�y 'R` �4f�,u'F'fTs t �.�.�` :- �.r�s+c ;1f+y�y .w,y.nrpq•yf-,.�.�e .?{:��:_ . . �� �l �� .. <br /> �� w�% �r'�e � <br /> . � �f 3- �z -�"� � f � , s . _ 9,'��5 , ' ""�����„� <br /> ��. <br /> � <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 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% of Contract Price* or Minimum Fee ($35.00) � <br /> x .0125 $ � r'U <br /> r��('�C�� � � <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. - ����j(; x .0005 $ <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) $ - . `�� <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for th�e�itted <br /> work including materials, labor, profit, and other fixed costs. It is the amount to be chafge� 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 .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: ; � Date: � _3 - <br /> � <br /> Approved By: _ Date: <br /> �{� .Y ,v kdlT � E� . . . . }. �� ) " .M' <br />�✓i -f*'�� ' ) 1 t.W�` � .. t - �� k� kf ..�� .y�. <br />�ry� R r F :;L J. & � � (Y � ' 5...�. �.:i vY' '. <br /> qs�'` � :i, S; '�' ! . . � �v> � rv l'�` s� 9"fi b <br /> �, � � ,� �,c �`�a " r�,#�y�+�..'�` <br /> `� .�^�. �e F� ^ Y p � ,` F y i� <br /> , . ., <br /> . . <br /> , <br /> l .: � . <br /> 4 - :- �. '. �'.. � <br /> . <br /> . <br /> ,. . <br /> r "� ; E 6. . �d �� ��� <br /> 4 � 1. <br /> .. . .:._ �, �_ . , . • . f • <br /> — <br /> + .'. .. <br /> , t �,' a <br />.�....es..�c.. . . . .... ,_. . . � Xre�F _ .'. h <br /> i ..�.Y � .. _ . ,.. .. .., n.e.. _ . _. re ._� <br />