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� . : . - - ,� S - <br /> _ . _.. . __ _ _ . . . _ -�- <br /> WOOD BURNING E4UIPMENT .. <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 , mi.n. flue dia /3 , ( �� _ <br /> To#al <br /> VENTILATION <br /> No, Kitchen Exhaust ducteii recirculating �� <br /> No. Bath Exhaust (must be ducted outside) �� <br /> No. Other Fans: Locations �� � <br /> . Total <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground i.nside outside <br /> Lp Gas: gallons <br /> Other Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25%a of Contract Price* or Minimum Fee «3�•���x .0125 $ <br /> (conuact price) <br /> 2. State Surchar�e. ** Add the State Building Code DiXisio�5 � <br /> Surcharge to each pemut. <br /> (contract price) <br /> or $.50, whichever is greater 1.50 <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ <br /> 4. TOTAL PERNIIT FEE (Add lines 1-3 above) � � ' ' �` <br /> * CONTRAC'T PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> work including materials, labor, profit, and other fued cosu. It is the amount to be charged to the <br /> customer for the work done. If any material, equipment, labor,or installation are fiunished 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 contnct 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 [he contract Pnce under $1,000,000 or $.50 - whichever is <br /> greater. For valuations over $1,000,00� call the DePart�ent 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 agplication are complete, true <br /> � and correct.-__-_�___� . <br /> -- .� _ _ _ _.. . ..:; I <br /> -- -�--. .._ � � : _ -�<<.:�.�Z� Date: % - �.�- ���/. <br /> _ Applicant's Signature: � <br /> � . Date: <br /> APProved By::_:.. : ' <br />