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Ili <br /> WOOD BURNING EQUIPMENT ' <br /> Wood stove with flue <br /> Wood combination or add-on � <br /> Factory fireplace with flue ,I <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. /'j � (�,�j <br /> VENTILATION � � � � ; <br /> No. Kitchen Exhaust ducted recirculating cfm I � <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 I <br /> t <br />� <br />�' PERMIT FEE CALCULATION j <br /> h ; 1. 1.25% of Contract Price* or Minimum Fee ($35.00) C <br /> x .0125 $ <br /> (contract price) <br /> 2. State Surchar� ** Add the State Building Code Division � <br /> Surcharge to each permit. �' � x .0005 $ <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e 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 estirnated 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 pernut 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 /> ; <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 /> and correct. <br /> Applicant's Signature: Date: (��-1 � <br /> Approved By: Date: j <br /> i <br /> � <br /> �, <br /> I <br />