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r <br />X <br />WOOD BURNING EQUIPMENT <br />____ Wood stove with flue <br />____Wood combination or add-on <br />____Factory fireplace with flue <br />____Factory Fireplace (s)_____ <br />Wood Stove (s) <br />Freestanding A Masonry <br />Franklin, other________ <br />Brand Name_____________ <br />Mfgr’s Min., Clearances, side rear <br />__Model No. _ <br />, min. flue dia. <br />Total jr>:TOO ca <br />VENTILATION <br />No.____ <br />No. ___ <br />No. <br />Kitchen Exhaust ducted recirculating <br />Bath Exhaust (must be ducted outside) <br />Other Fans: Locations__________ <br />cfm <br />cfin <br />cfin <br />Total <br />FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br />____ Installation ____ Removal <br />____ Fuel oil: ____ gallons ____ underground ____ <br />____ LP Gas: ____ gallons <br />Other ___________ ___ <br />inside outside <br />Gas opening <br />PERMIT FEE CALCULATION <br />1. 1.25 % of Contract Price* or Minimum Fee ($35.00) <br />X .0125 <br />2. <br />3. <br />4. <br />(contract price) <br />^Sfate Surcharge. *♦ Add the State Builduig Code Division <br />Surcharge to each permit. __________________ x .(X)05 <br />(contract price) <br />or $.50, whichever is greater <br />Postage and Handling (Only mail-in applications) <br />TOTAL PERMIT FEE (Add lines 1-3 above) <br />$ <br />$ <br />$ <br />1.50 <br />* CONTRACT PRICE or JOB COST nwans the actual or cstim;^ dollar amount charged :or the permitted <br />work including materials, labor, profit, and other fixev. vosts. It is the amount to tv> 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 mark^ value of such items must be added to the estimated cost <br />or (X'ntract price for permit fee purposes. In the event that there is a dispute on the amount of d>e job cost, <br />the City 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 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 />Applicant’s Signatu <br />Approved By:___ <br />/ * 0\-