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�'* . , k ��,�.-�.__ _ �4 �i��` �A?:,'�'j. ^,r":�sc�fL����Y .'l'�l;C'A'4 _"',rs�:T�Tm �E� ..1 _ 'Y r 7 <br /> r ��; <br /> 6� <br /> f�� <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 />�, Total <br /> VENTILATION <br /> No. � Kitchen Exhaust ducted recirculating �� cfm <br /> No. �_ Bath E�aust (must be ducted outside) �� cfm��,.� <br /> No. -- Other Fans: Locations �� <br /> 'I'otal <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 /> PERl�ZIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee 35.00 <br /> oJ x .0125 $ .�� � <br />�.. <br /> (contract price) <br />�r 2. State Surchar� ** Add the State Building Code Division ,�— <br />�; Surcharge to each permit. �-�— x .0005 $ � • �� <br />��,+ (contract price) <br />�,,; or $.50, whichever is greater <br />:�_` 3. Posta�,e and Handling (Only mail-in applications) $ 1.50 <br /> 4G 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �� <br /> * CpNTRACT PRICF 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 />�::r� 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 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 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 />�,:_:: <br />.�;' and correct. <br /> � <br /> ^ /' Date: —/.5�— 5' <br /> Applicant's Signature: � <br /> Approved By: Date: � <br />