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WOOD BURNING EQUIPMENT <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 , min. flue dia. <br /> VENTILATION <br /> No. I Kitchen Exhaust ducted recirculating cfm <br /> No. C Bath Exhaust (must be ducted outside) 73 cfm <br /> No. Other Locations �,,,, t, 42,- cfm <br /> ciM• —7 a <br /> FUEL STORAGE (MUST BE APPROVED Y FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other NAT, („q.S - ',7r fe r, CeeKroP, Leg 7 Gas opening I <br /> cot,VO.C2$, 1 -VN i }AGA <br /> :Ter , - I — iZeu�„ r i <br /> - �.el .4ror ;(J lre. UN:'C ke - - <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> /17)1100 <br /> on x .0125 $ a 17.50 <br /> (cont4act price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ 70 <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) $ 2a 7,7CI <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 sigged 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 'th the ordinances of the City and the regulations of the Minnesota <br /> State Building Code, and cell i ' . that all statem- it .de on this application are complete, true <br /> and correct. <br /> Applicant's Signature: � Date: /2 - 3 - <br /> Approved By: 1 Date: �b )2 [ <br />