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, . . _ i �, <br /> � <br /> �" , ,.��� . � � " . � �°' i�- . ., � �. � � � � ' ' y <br /> WOOD BURNING EOUIPMENT <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 /> � <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 /> 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 /> � <br /> PERMIT FEE CALCULATION �6� s ; <br /> 1. 1.25% of Contract Price* or Mi� m F e 35.00 ' <br /> ��jn x .0125 $ <br /> �ontract price) <br /> 2. State Surcharge. ** Add the State Building_Code Division � <br /> Surcharge to each permit. 5�`_� `�-' 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 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 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 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 Buildin Code and certifies that all state ents made on this a lication are com lete, true � <br /> g , PP P �: <br /> and correct. <br /> '� <br /> �3 <br /> Applicant's Signature�:-- Date: � 2c� '�j ,�,: <br /> / � r�~t <br /> Approved By: Date: ���; <br /> �.; <br /> 9 � � <br /> I . <br /> I° <br /> ' i <br />