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� � �.. ��'� . -`�` �. �' ,� .��a::��' . , . ti ... �. , �'� '.��`.r-- k�'<:;�:. � �:z'� <br /> � <br /> �. <br /> WOOD BURNING EQUIPMENT <br /> Woad 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 /> x, <br /> Brand Name Model No. ; <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. �� <br /> Total � <br /> � <br /> VENTILATION �' <br /> r1o. Kitchen Exhaust ducted recirculating cfm ' <br /> F <br /> No. Bath Exhaust (must be ducted outside) cfm <� <br /> No. Other Fans: Locations cfm � <br /> Total �� <br /> � <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 /> � <br /> ���� :,�` x .0125 $ �`� <br /> �� � <br /> (contract price) =h <br /> 2. State Surcharge. ** Add the State Building Code Division � <br /> Surcharge to each permit. x .0005 $ ; <br /> (contract price) '� <br /> or $.50, whichever is greater ;� <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 :� <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ '$ <br /> * <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 /> customer for the work done. If any material, equipment, labor, or installation are furnished by the owner, i.� <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 /> ,� <br /> � <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 /> � <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. _�- `'a <br /> �/'�/ ____ <br /> Applicant's Signature: C - � Date: �Z� s' '� <br /> Approved By: Date: <br /> � <br /> E.,s:� :.�. __. . � :�:, .u�...,��. ......,_.F r . �.. . _ .�r..��.�_..�,. .u, _,..��., .�.._ _._�.� ._. _�._.._ - -�,,..�.. <br />