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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) Freestandin. ) Masonry <br /> Wood Stove (s) Frank ,::her <br /> Brand Name :yodel No. <br /> Mfgr's Min., Clearances, side , rear in. flue dia. <br /> Total <br /> VENTILATION <br /> No. Kitchen Exhaust ducted _ recirculating cfm <br /> No. Bath Exhaust (must be ducted ou° cfm <br /> No. Other Fans: Locations cfm <br /> • Total <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE .2SHAL) <br /> Installation Removal <br /> Fuel oil: gallons under nd inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($3 <br /> .0125 $ 7Soo <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Cock ;.cion <br /> Surcharge to each permit. . .0005 $ <br /> (contract price) <br /> or $.50, whichever is greater <br /> 3. Postage and Handling (Only mail-in applicatic $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above $ <br /> * CONTRACT PRICE or JOB COST means the actual or est :1 dollar amount charged for the permitted <br /> work including materials, labor, profit, and other fixed It is the amount to be charged to the <br /> customer for the work done. If any material, equipment, 1: or installation are furnished by the owner, <br /> tenant or any other party the reasonable market value of s ,rms must be added to the estimated cost <br /> or contract price for permit fee purposes. In the event that is a dispute on the amount of the job cost, <br /> the City may request the submission of a signed copy of ctual contract. <br /> ** The STATE SURCHARGE is .0005 of the contract prix :der $1,000,000 or $.50 - whichever is <br /> greater. For valuations over $1,000,000 call the Departn :u Inspectional Services for the price. <br /> The undersigned hereby applies to the City for issuance. a Mechanical Permit, agrees to do <br /> all work in strict accordance with the ordinances of the C _nd the regulations of the Minnesota <br /> State Building Code, and certifies that all statements ma, a this application are complete, true <br /> and correct. <br /> Applicant's Signature: �� <br /> � Date: /- - /L-/- Q6/ <br /> Approved By: - Date: <br />