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, <br /> WOOD BURNING EOUIPMENT <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 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 /> �,���'.,�i x .0125 $ <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> -� Surcharge to each permit. x .0005 $ <br /> or $.50, whichever is greater (contract price) <br />� 3. Postage and Handling (Only mail-in applications) $ 1.50 <br /> < 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ <br /> y: <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 /> or contract price for pernut 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 t]�at all state nts made on this application are complete, true <br /> and correct. � <br /> Applicant's Sig ture: � Da : ` �- � <br />,.�.�,.L.. . <br /> Approved By: � Date: ��9/�� <br /> ..., _,_ . .... .� .. . . .. . . .�. ! , . ... _ . . . .. . . . .. � s <br /> t <br />