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;�,� <br /> �w r <br /> \ �! <br /> � <br /> ;� <br /> � <br /> WOOD BURNPi 1G EQUIPMENT � <br /> i <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 E�aust ducted recirculating cfm ;.:r <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 /> ' ��� <br /> � � � <br /> ERMIT E C C TION <br /> l. 1.25% of Contract Price* or Minim ee 35.00 U� <br /> r x .0125 $ �� <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ s �� <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> �. TOTAL PERMIT FEE (Add lines 1-3 above) $ ���J --� <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 /> 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 ak1 statements made on this application are complete, true <br /> and correct. '" <br /> �/� <br /> Applicant'sSignature: C-�. - Date: �% � <br /> Approved By: Date: <br /> �� : .� ,., � � ;_-�-_ , . i , , <br />�a .. , , �� <br /> _� <br />�.�.., ki� <br />