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� <br /> . <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 Mode1 No. <br /> Mfgr's Min., Clearances, side , rear , mi.n. flue dia. � <br /> Total <br /> VENTILATION <br /> No. / Kitchen Exhaust � ducted recirculating �� <br /> No. ,�� Bath Exhaust (must be ducted outside) �� <br /> No. Other Fans: Locations �� � <br /> . Total <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAI-) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas openi.ng <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) g� <br /> j.���va x .0125 $ ��� <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division �S2;- <br /> Surcharge to each permit. 1) E C%�c� x .Q005 $ <br /> con�( tract price) <br /> or $.50, whichever is greater 1.50 <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ . S� <br /> 4. TOTAL PERNIIT FEE (Add lines 1-3 above) � <br /> * CONTRACT PRICE or JOB COST means �L ac�,�a�or_stimated r.loll�r unonnt ch�xged for the permitted <br /> work including materiais, labor, profit, and other fized 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 parry the reasonabie market value of such items must be added [o 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 �°ntract• <br /> ** The STATE SURCHARGE is .OQOS of the contract price under $1,OQ0,000 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 Perm.it, agrees to do <br /> all work in strict accordance with the ordinances of the City and the regulations of the Minnesota <br /> State Buildi.ng Code, and certifi that all statements made on this application are complete, true <br /> � and correct.---.----.---- � _ <br /> _ . ,� :� ;,s: � � <br /> � Date: �Q��/ <br /> _ Applicant's Signature: � `—�- <br /> � -_ ' j� _ `� Date: �j � �� <br /> Approved By:--�:_ : , <br /> _ _ � ; . <br />