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,._ _ .. ,� � <br /> , <br /> �. � <br /> � C �C> � �- <br /> ��86� BURNING E�UIPMENT <br /> Wood stove with flue � <br /> Wood combination or add-on <br /> _;� Factory fireplace with flue f,%:x P��jcc•�t � �21 c� s�'� � ' <br /> � Factory Fireplace (s) Freestanding Masonry . <br /> Wood Stove (s) _ Franklin, other � <br /> Brand Name /�a ��(e��� =- ✓1�c�S�5�-, L Model No. r; ny a��� - '�� C•L�i/�,�t� <br /> Mfgr's Min., Clearances, side � , rear , min. flue dia. <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfin <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <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 (v UC� ��� x .0125 $ � �, ;�� ;�} <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division � � <br /> Surcharge to each permit. ,� ;;� C C� x .0005 $ � � <br /> or $.50, whichever is greater (contract price) _- <br /> 3. Posta�e and Handling (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 /> 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 fumished by the owner, <br /> tenant or any other party the reasonable market value of such items must be added ta thc estimated cost <br /> or contract price for pemut 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 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 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 application are complete, true <br /> and correct. <br /> n ! <br /> � ��' �� � <br /> Applicant's Signature: _ ���z,.. �V�,✓v�--� /Vl�i1 Date: 1 �r( ��'6 <br /> Approved By: Date: <br /> _ _ ' j� . <br /> r;; _ <br />