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WOOD BURNING EQU PWNT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue <br /> 'Factory Fireplace'(s) Freestanding Masonry <br /> Wood st6vi7(s) Franklin;other <br /> Brand Name Model No. <br /> ' Mfgr's Min.,;Clearances,;side rear min:''flue dia. <br /> VENTILATION <br /> No. Kitcfien,Exhaust ducted recirculating cfm <br /> No. Bath Exhaust .(must be ducted outside) cf n <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 /> PERMIT FEE CALCULATION <br /> 1Y.25 q.of Contract Price* or Minimum Fee:($354t?) <br /> x. 015 $ ' <br /> (contract price) <br /> 2 ' _State=Surcharge .**Add-the,State Building"Cade DDivision _ <br /> Surcharge to;;each permit; �, x .00©5 $ 07,43, <br /> or'$:50, whicheyeras=greater (contract price) , <br /> 1, ' Postage and Handling (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 /> - -`cttstomm fore wo3k�lone —If any materiat;equipment, labor,-or installation are iumisiied`biiy tMe 4 w-_ <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 worn'in SuiCt accordance with the.ordiri,ar=s of it e C ity.gnu'u' a regulations of the Minnesota <br /> St4WBuildtzzg:Code,-and certifies,that;all statements made on this application-fare complete, true <br /> and.correct. <br /> Applicant's Signature: Date: <br /> Approved By: Date. <br />