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�� � <br /> WOOD BURI�TING EQUIPh1ENT <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 Narric��.Gl���e- ,.lv'� E-�,,�.�:;�f��;�� , Mode1 No. y� ti'� �" �;�'1'`���'-- '��J-- <br /> Mfgr's Min., Clearances, side. , rear , min. flue dia. <br /> -=--,��=' �v <br /> _ Total "�."=",�-�. c'^t`� <br /> VENTILATION <br /> No. Kitchen E�chaust ducted recirculating cfm <br /> No. Bath E�chaust (must be dt�cted outside� cfm <br /> *r.. ��<�...._. r, . T . <br /> .,,;. ��.,.,� �. tlAiJ. 1Nti+4LlV11J cim <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 o�ening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.0� <br /> ��' �',-� x 1.25 $ �, 1 �L.� <br /> (contract price} <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcriarge to each permit. ��,`�^s?• ���. x .0005 $ � . � Q�� <br /> ��(contract price) <br /> 3. Postage 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 /> ,.i • �.. ': .. P.:u.a t� L � r � - r.:. _ � � �_-A T` }� i._ <br /> W',iiA ilil.l�.lUS:'7 �.11aa:.� 1�:)v.� YiJll�� [.i::l vilii:l� 11AGu l.V�i��. � :J lI1G' dli'i�.+ii LV UC Ll::u�l: i:) La.i- <br /> customer for the work done. If any material, equipment, labor, or installation are furnished by the owner, <br /> tenant or any other parry 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[he 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 Cir,� 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 cerr.ifies that all statements made on this application are complete, true <br /> and correct. <br /> Applicant's Signature. � � Date: � �i � <br /> Approved By: • Date: � �� <br />