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: � <br /> " `c�s _L`' <br /> � �� P . <br /> U <br /> WOOD BURNING EQUIPMENT a,�,I`a' �, �� <br /> Wood stove with flue / 1`n� ���.�� <br /> Wood combmation or add-on , <br /> Factory fireplace with flue <br /> Factory Fireplace (s) Freestanding Masonry <br /> Wood Stove (s) Franklin, other <br /> Brand Name Gt,�- -tJ -C�I C� Model No. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> Total <br />� VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfin <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations �� <br /> TQtal <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 /> �D.C� x .0125 $ �J� �d v <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. U�-� x .0005 $ � � <br /> (contract price) <br /> or $.50, whichever is greater <br /> 3. Posta�,e and Handlin� (Only mail-in applications) $ 1.50 ,_ <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �� -U� �_ <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 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 all statements made on this application are complete, true <br /> and correct. <br /> Applicant'sSignature: �.�_ �� ��,�� C-�- Date: �� 1 <br /> Approved By: Date: <br />