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�'.� � � <br />�� <br /> � s� <br />.�. <br />.�k: <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. � <br /> VENTILATION <br /> No. Kitchen E�aust ducted recirculating cfm ;� <br /> No. Bath Exhaust (must be ducted outside) cfm � <br /> No. Otr.er Fans: Locations cfm � <br /> � <br /> � <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal `� <br /> Fuel oil: gallons underground inside outside � <br /> ; <br /> LP Gas: gallons ';' <br /> t°. <br /> Other Gas opening <br /> =� <br /> PERMIT FEE CALCULATION - <br /> 1. 1.25%o of Contract Price* or Minimum Fee ($35.00) <br /> x .0125 $ <br /> ;contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ �� <br /> or $.50, whichever is greater (contract price) �� <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ' <br /> � <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 value of such items must be added to the estimated cost <br /> or contract price for pernut 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 /> :�� <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. r� <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do <br /> all work in strict accardance with the ordinances of the City and the regulations of the Minnesota <br /> State Building Code, and ce ' es that all statements made on this application are complete, true <br /> and correct. <br /> Applicant's Signature: Date: � � �� <br /> Approved By: Date: <br /> �;; <br /> � z,y � µ <br /> �: . <br /> `,( . � . . ' . .. . . . � � � , . . . . . . . . aF, <br /> � <br />� . 'r : a ' . ' .. � � . � . .. - . . . . . . , .. <br /> .. . . . �:. 1��� � r � ' �, � Y <br /> • <br /> R � � � .:, ' ' j{ � . " ' . . , f .. . . . <br /> S�� <br /> � ' ��. .: F .. � - � .. f .^vf . ' . . ' , ` }y� <br /> ' ;��' �, `. . � � . � � 'My3� <br /> � . . ',�. _ . . ' . . . <br /> •; •' '� w..na: -1'_ .�i4 <br /> �:: r .. i. ':. . : , . . . <br /> �.: . 1.. , . • . <br /> c .. .. . rc �:��..' ...�_t._sr�:. r _.r'.'t... .: �:�.:� .. �.�. .. .�.. (...e5 �..� � . . . .. .�. . ' _. . . .. . - r. . . <br />