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�x,..-F � � .-f�� n. .... . ..._' :�.., ...> � � . . <br /> . . ,.... ,.. . .. .. . . . . .. . <br /> . . .. , . .;. .. . <br /> ( <br /> , , . . ..i� ... . . . . . . . � .. <br />�� r � .: � ' - ' . . . . . . . . ... :_. .... <br /> t ... ;` '.. .� � �� ... � . � . . <br /> F� n4; .. _ z _ � ._... _ _ ... , .-. <br />� 4 . � . .. - ... - .. . . . ^� ,.. <br />� ' <br />'4` 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 />�� Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> Total <br />�; <br /> VENTILATION <br />�� No. Kitchen Exhaust ducted recirculating cfm <br />- �,'o. �a� Lxhaust ��r.ust be uucted oLtsid�) �f:r <br /> k' No. Other Fans: Locations �� <br />� <br /> t:. Total <br />�- <br />, <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��l�IIT FEE CALCUI.AT'ION <br />� 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br />;. ����-�; `� x .0125 $ :3S ��� <br /> (contract price) <br />� 2. State Surcharge. ** Add the State Building Code Division ,, <br /> Surcharge to each permit. x .0005 $ ���� <br /> (contract price) <br /> or $.50, whichever is greater <br /> 8 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 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 fumished 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 tbe 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 all statements made on this application are complete, true <br /> and correct. <br /> Applicant's Signature: Date: / 07 ' ��_ �S <br /> Approved By: Date: C� L� �� <br />