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.; <br /> ;; �, <br /> � <br /> . <br /> �?� S <br /> t:, <br /> � <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 /> ��. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> Total <br /> VENTILATION <br /> No. �_ Kitchen E�aust hooG� ductecl recirculating cfm <br /> No. _� Bath E�aust (must be ducted outside) cfm <br /> No. �_ Ot�'�er �rans: i.ocatior�s �1 ,�y e C' �� <br /> Total `�J <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> y � Fuel oil: gallons underground inside outside <br />�` LP Gas: gallons <br />�° <br />� ' <br /> Other Gas opening <br />� ; <br />�_' PERIVIIT FEE CALCULATION <br />��� 1. i.2��o of Contract r�rice* or Minimum l�ee ($3�.00) <br />�. <br /> ����000. 00 x .ol2s $ 33'7.s-O <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division =� <br /> Surcharge to each permit. � ���00, 0 C� x .0005 $ /3. �d ��� <br />� (contract price} <br /> � or $.50, whichever is greater <br />��; <br /> f�r 3. Postage and Handlin� (Only mail-in applications) $ 1.50 <br />�,,: <br />�'; 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ,3� ,�'� <br />��- <br />�; <br /> * CONTRACT PRTCE or JOB COST means the actual ar estimated dollar amount chazged 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 /> r r` the City may request the submission of a signed copy of the actual contract. "� <br />%� .-„i <br />.3� <br />`'' ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is <br />�.;,; <br /> greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price. <br />:�` <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 conect. . <br /> Applicant'sSignature:,.` Date: � — �'� <br /> � :�; <br /> Approved By: <br /> � Date: a —� v � <br />