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WOOD BUR-NTENG EQUIPMENT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue Masonry <br /> Factory Fireplace (s) Freestanding �Y <br /> Wood Stove (s) Franklin, other <br /> Brand Name Model No. <br /> MfQrIs viin., Clearances, side , rear . min. flue dia. <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculatingcfm <br /> No. Bath Exhaust (must be ducted outside) cfm cfm <br /> No. Other Fans: Locations <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 /> PERMIT FEE CALCULATION �� <br /> 1. 1.25% of Contract Price* or Mini-mum <br /> oFee 35.00 x .0125 $ � <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. '� x .0005 $ <br /> or S.50, whichever is greater (contract price) <br /> 3. Postage and Handling, (Only mail-in applications) <br /> $ 1.5= <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 he <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 /> of the <br /> ract price <br /> o,000 or <br /> ** <br /> 7-re o SURCHARGE valuations overtS1,0005000 ccallcthetDepartment ofeInspeccttiional Services Ofor hwhichever is <br /> price <br /> ere..ter.er. For <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: <br /> Date: <br /> Approved By: <br /> Date: <br />