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_ � " a►. <br /> WOOD JBURNING 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 Mi.n., Clearances, side , rear , min. flue dia. <br /> Tatal <br /> VENTILATION <br /> No, Kitchen Exhaust ducteci recirculating �� <br /> No. Bath Exhaust (must be ducted outside) �� <br /> No. Other Fans: Locations �� - <br /> . Totat <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 /> 1. 1.25% of Contract Pricek or Niinimwai �'� 1�.:�5.v�-�� <br /> /�� dv , �� c� x .0125 $ �C'�� U �' <br /> {contract pr,'ce) <br /> 2. State Surchar�e. ** Add the State Buildi.ng Code Division ��� <br /> Surcharge to each permit. / o C��� _ x .0005 $ <br /> (contract price) <br /> or $.50, whichever is greater � � �� <br /> 3. PostaQe and Handlina (Only mail-in applications) $ <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) � � � � 3�� <br /> * CONTR.AC'T PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> work including materials, labor, profit, and other fued cosu. It is the amount to be charged to the <br /> customer for the work done. If any material, eauipment, labor, or installation are furnished by the owner, <br /> tenant or any other parry 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 cnst, <br /> the City may request the submission of a signed copY of the actual contract- <br /> ** The STATE SURCHARGE is .Q005 of the contract price under $1,QOO,Q00 or $.SO - whichever is <br /> greater. For valuations over $1,000,000 ca11 the DePart�ent 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 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 /> _ _ � _- �r�..� :;: �-c..��_ �c� Date: �a � 1 '�� <br /> _ Applicant's Signature: <br /> _ Date: <br /> APProved By: - � <br />