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� <br /> � s <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 /> Mfgr's Min., Clearances, side � �` , rear �� �' , min. flue dia. i=? X i �� <br /> Total /�y `�; �,- , <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 /> Total <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 Surchar� ** Add the State Building Code Division <br /> Surcharge to each permit. 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) $ <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 /> t:� 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 the job cost, <br />'r� <br /> the City may request the submission of a signed copy of the actuat 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 />" .� <br />�` The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do <br /> 4 ' 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 />�' ��- ,�--_ -�_.:�-„_,_,_ Date: i� � �_ � r <br /> Applicant's Signature: `� <br /> Approved By: Date: <br />,� : _ ___ u, , . . _ _ ... ;;.� <br />