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. . . , � <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. ��n —C �11��4"� <br /> Mfgr's Min., Clearances, side _�, rear �, min. flue dia. �jE' _ <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> - - No. Other Fans: Locatior.s cfm <br /> � <br /> kt�r <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 $ .�j ,C�� <br /> (contract price) <br /> �' 2. State Surcharge. ** Add the State Building Code Division <br /> � � <br /> - Surcharge to each permit. � ,�� x .0005 $ • X� <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta e and Handlin nly mail-in a $ 1.50 <br />, 4. TOTAL PERMIT F lines 1-3 above) $ ?7 ��L? _ <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, <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 /> •r 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 /> 1 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 /> _ A licant's Signature: (�?� � `� Date: � �� <br /> rr <br /> ; <br /> Approved By: Date: <br />:; <br />�. . , <br />; , : � >�:�-�, . . .. <br />,. . <br /> , � ..�. , � �' _ . - <br />