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WOOD BURNING E( <br />Wood stove with flue <br />Wood combination or add-on <br />Factory fireplace with flue <br />Factory Fireplace (s)____ Freestanding ___ <br />Wood Stove (s) ' • .____ Franklin, other <br />Masonry <br />Brand Name Model No. <br />Mfgr’s Min., Clearances, side rear min. flue dia. <br />VEi CUl:.ATION <br />No.____ <br />No.____ <br />No. <br />Kitchen Exhaust ducted recirculating cfm <br />Bath Exhaust (must be ducted outside) <br />Other Fans: Locations <br />cfln <br />cfm <br />FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br />Temp X Installation __ Removal <br />____ gallons ____ underground ____ <br />____ gallons <br />Fuel oil: <br />LP Gas: <br />inside odtside <br />XX Other Gasoline Tank - temporary Gas opening <br />PERMIT FEE CALCULATION <br />1. 1.25% of Contract Price* or Minimum Fee (S35.001 <br />X .0125 $ <br />2. <br />(contract price) <br />State Surcharge. ** Add the State Building Code Division <br />Surcharge to each permit. _______________ x .0005 $ <br />or $.50, whichever is greater (contract price) <br />3. <br />4. <br />Postage and Handling (Only mail-in applications) <br />TOTAL PERMIT FEE (Add lines 1-3 above) <br />$ <br />$ <br />1.50 <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 ai^ other party the reasonable ma^et value of such items must be added to the estimated cost <br />or contract price for pennit fee purposes. In the event that there is a dispute on the amount of the job cost, <br />the City may request the subi^ssion of a signed copy of the actual contract. <br />*• The STATE SURCHARGE is .0005 of the contract price under $1,009,000 or $.50 - whichever Is <br />greater. For valuations over $1,000,000 call the Depanment 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, tnie <br />and correct. <br />Applicant ’s Signature:Date: <br />Approved By:Date: