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f <br /> G` ` <br /> e` <br /> G' � <br /> i . <br /> Ir , ,� <br />� WOOD BURNING EQUIPMENT , ;.� <br /> Wood stove with flue !,� �, � <br /> Wood combination or add-on �-- U� � <br /> v <br /> � Factory fireplace with flue ; <br /> Factory Fireplace (s) Freestanding Masonry <br /> Wood Stove (s)r,.. Franklin, other <br /> Brand Name -1/i,'��� `������� �� Model No. �(.�:5':.L..- -%� <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 /> ``�fi �JF.i, STQ�.ArT!, (MTicT �F APPRO��ED �Y FIRF �,�aR�ga��) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> PERMIT FEE CALCULATION 1���� <br /> 1. 1.25% of Contract Price* or Minimum Fee 35.00 �� � <br /> _ ;r`�' x .0125 $ � <br /> (co tract price) <br /> 2. State Surcharge. ** Add the State Buildin o��ivision `r� <br /> Surcharge to each permit. > � x .0005 $ /'f 1 �' <br /> or $.50, whichever is greater contract price),� �_, <br /> �� tj•, �' . (. <br /> 7 <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT PEE (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 furnished by the owner, <br />�� tenant or any other party the reasonable market valu�; 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 />� ** <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 /> �:; <br />��' <br />�� <br />��= The undersigned hereby appli�,s to the City for issuance of a Mechanical Permit, agrees to do <br />�� all work in strict acc�rc".ance with the ordinances of the City and the regulations oi the Minnesota <br />� <br /> State Building Code, and certifies that all state�nts made on this application are complete, true <br /> and correct. ` ` � <br />��` J �/ � �1 (�' <br /> �`` A licant's Si nature: �� 'i ! � �� �l� Date: C% 1 <br /> �.>. PP g <br /> �� <br /> ,��'i <br /> Approved By: Date: <br /> __._ _ _ _ _ �.. _._ ,. . <br />