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WOOD BURNING EQT W— N'Y' <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue <br /> Factory Fireplace (s) Freestanding Masonry <br /> Wood Stove (s) Franklin, other <br /> Brand Name Model No. <br /> Mfgr's Min., Clearances, side , rear thin_ flue dia. <br /> Tota! <br /> VENTILATION <br /> No, Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfrn chn <br /> No. J-� Other Fans: Locations Total _ <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 /> PE IT p'EE CALCULA'l'ION <br /> 1. 1.25% of Contract,Price,* or Minimum i , $ ($35.00) .0125 $ /50- the <br /> (contract price) <br /> 2. State S rcharg " Add the State Building Code Division <br /> Surcharge to each permit. / �� x .0005 $ 6 . c e <br /> (Eontract price) <br /> or $.50, whichever is greater $ 1.50 <br /> 3. Postage and Handling (Only mail-in applications) - <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ / 5?- 50 <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 Ciry 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 Servicca 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 certiftcs that all statements made on this application are complete, true <br /> and correct. <br /> Applicant's Signator <br /> Date: <br /> I <br /> Approved By: ��i� Date: <br /> £00 LS2L-21..P—ZT9 ONOc1O d■ ALIO 3HL 60:60 P6/22/0T <br />