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�' � <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 Exhaust ducted recirculating cfm `�� <br /> No. Bath Exhaust (must be ducted outside) cfm � <br /> No. Other Fans: Locations cfm '; <br /> ;i <br /> FUEL STO�tAGE (MUST �E 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 /> ���(�� „ -� x .0125 $ <br /> (contract price) <br /> 2. State Surchar�,e. ** 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 PEE (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 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 S'fATE 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 appli�s to the City for issuance of a Mechanical Permit, agrees to do <br /> all work in strict accurc!ance 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 /> nt'sSi nature:% U✓ Date:� _ � � <br /> Applica g � <br /> Approved By: Date: <br /> :� <br /> `�: <br /> k5 . 3�y ,�t <br /> �. <br /> : ' ���4 , �� . . . . � e. ���„}, {-. <br /> y� . ' , <br /> 5 � ' y <br /> � <br /> e t . , - ,. .. , . <br /> , .� <br /> �i ,.,.�.c ,., ....�„m. .. .. ... ... . .. _ . . /.. .� .. � � . .. —... .... .... .. .,.. �,m.:� <br /> .-.w�n;:....... ..... ._ ,., .,. , ...._. : �-�. <br />