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__ �. <br /> WOOD BURNING EQUIPMENT <br /> � Wood stove with flue <br /> � Wood combination or add-on \ <br /> � Factory fireplace with flue ���� <br /> e <br />��> � Factory Fireplace (s) Freestanding Masonry �y ��� � <br />�'; Wood Stove (s) Franklin, other �� f , <br />�� Brand Name��Sf;� _ Model No. S/�G�Z , �'�¢� <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br />� i <br />�: 5�t-�/r� 3 z <br /> VENTILATION L 34 z -� �� ��L <br />�� No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath E�chaust (must be ducted outside) cfin <br /> No. Other Fans: Locations �� <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 /> E�� <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) , <br /> Y; <br /> � � x .0125 $ <br />�, _�-r�' - <br />��� (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> j Surcharge to each permit. x .0005 $ <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e 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 the pemutted <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 />�:=� <br />�;- or contract price for pemut fee purposes. In the event that there is a dispute on the amount of the job cost, <br />�, <br /> the City may request the submission of a signed copy of the actual contract. <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 /> 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 conect. <br /> Applicant's Signature: ��1� <br /> � Date: � — <br /> Approved By: Date: <br />