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N Ori 5° Zvi Rtn��nt> L *core: <br /> = bA LIP-560 A5,W, <br /> WOOD BURNING EQUIPMENT hA <br /> Wood stove with flue <br /> combination or add-on <br /> Factory fire 'th flue <br /> Factory Fireplace (s) standing Masonry <br /> Wood Stove O Franklin,-ether <br /> Brand Name Model No. <br /> Mfgr's Min., Clearances, side rear min. flue dia. <br /> VENTILATION N A <br /> Nb----____KitchenExhaust ducted recirculating cfm <br /> No. Batha ducted outside) cfm <br /> No. OtherFans: Locations cfm <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation X Removal <br /> Fuel oil: 2-151,0 gallons underground inside X 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 /> 1, <br /> r/00 x .0125 $ 3 Cj <br /> —T(contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each per mit. 1, 06O x .0005 $ ' 50� <br /> or $.50, whichever is greater (contract price) <br /> 3. Postage and Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 37,00 <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 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: \llp Mod-Ii CJS Date: 7 ZZ19& <br /> lq�Approved By: Date: �L <br />