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'�, <br /> � <br /> ;� . <br /> >� - <br /> ,;, <br /> ;# <br /> :t <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 �E APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> � <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 /> 15 , �C°� �O�_ x .0125 $ I�-t I,�`� <br />� ' (contract price) <br />�� 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. �5� �(`�.(�(� x .0005 $ r]. � <br /> or $.50, whichever is greater (contract price) � <br /> `� <br /> k��� 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �•� <br />`1.: <br />� � <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollaz amount charged for the permitted <br />�: work including materials, labor, profit, and other fixed cos[s. It is the amount to be chazged to the <br />'��t,' <br /> ,,, customer for the work done. If any material, equipment, labor, or insta!lation are fisrnished.by the owner, <br />:e�;�as. <br />`> !i 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 /> s '. <br />�`,, ** The S'TATE 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 /> r'; <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do <br />�� all work in strict acc�r�'a e with the ordinances of the City and the regulations of the Minnesota <br /> - State Building Code, an ifies that all ents made on this application are complete, true <br /> and correct. - � <br /> Applicant's Signature: Date: �(�'�'��v `� <br /> Approved By: � ' Date: �' 7 � <br />�.< <br />