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1711-1997 3:22PM FROM FIRESIDE CORNER 612 633 8884 P. 3 <br /> WOOD RLMNIMG E0tWnZN'T' <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue <br /> Factory Fireplace (S) Freestanding Masonry <br /> Woad Stove (s) Franklin, other <br /> BrAad Name Model No. <br /> Mfgf s Min., Clearances, side , rear min.flue dia. . <br /> VENTII.ATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No- Bath Exhaust (must be ducted outside) efm <br /> No_ Other Fans- Locations efrn <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation' Removal <br /> Fuel oih gallons _ underground inside outside <br /> LP Gas: gal?ons <br /> Other Gas opening <br /> STT M CALCULATION <br /> 1. 1.251 of Conmet Price* or Minimum Fee (W.00 _ <br /> 1l('y')Cf-) x .0125 S <br /> (contract price) <br /> 2. fit.Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. x <br /> or S.50, whichever is greater (wait ct,price) <br /> 3. Postage an H� (Only mail-in applications) $ l 50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amoum charged for the permitted <br /> work including materia[s, tabor, profit. and other fled costs. R is the amount to be charged to tate <br /> customer for the work done. If any material, equipment,iabm, or installation are furnished by the owner. <br /> tenant or auy odder parry the reasonable marker value of such irems must be added to the estimated cost <br /> or conuact price for permiiu fee purposes. Ln the event that tdzere is a dispute ora the amount of the job cost, <br /> the Ciry may request the submission of a signed copy of the atxttal coomm. <br /> ** The STATE SURCHARGE is .4005 of the contract price under 51.000,000 or $.SO - whichever is <br /> greater. For valuatiow over$1.000,040 call the Depattmem 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 ac=danee 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: r Dace. <br /> Approved By: Date: <br />