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1 <br /> WOOD BURNING EQUIPMENT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fueplace 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 /> Total <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 /> � <br /> PERMIT FEE CALCULATION y sq6 <br /> 1. 1.25% of Contract Price* or Minimum Fee 35 0 � <br /> � �, x .O l 5 $ �5 5�' <br /> (contract ice) � <br /> 2. State Surchar�e. ** Add the State Build' Code Division \ � -Z <br /> Surcharge to each permit. '� ��. �, ��- x .0005 $ � <br /> 4contract price) ' <br /> or $.50, whichever is greater 1.50 <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ , <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ .�� �-t Q <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 ownery <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[hat there is a dispute on the amounc of the job cost, <br /> the City may request the submission of a signed copy of the actual conaact. <br /> ** The STATE valuations over i$1,0005000 call cthet Department nof Inspec�onal Services for the lpnceer is <br /> greater. For <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 s em�n made on this application are complete, true <br /> � <br /> and conect. � _ '� - <br /> ' . _ ��- � " C1 �� <br /> ,� �L Date: �-- i -� <br /> Applicant's Signature: <br /> �l <br /> Date: a `" (� ', �� <br /> Approved By: <br /> # <br /> � <br />