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r'�� ,r <br /> a <br /> . ,e <br /> WOOD BURNING EOUIPMENT <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 /> Total <br /> VENTII.ATION <br /> �No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations �� <br /> . Total <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 Price* or Minimum Fee ($35.00) <br /> ��Qp, � x .0125 $ �V�°� <br /> (contract price) <br /> 2. State Surcharge. *'� Add the State Building ode Division I �� <br />� Surcharge to each permit. ��� � -x .0005 $ � <br />� (contract price) . . . <br /> or $.50, whichever is great�r <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.5 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �,�7�� <br /> '� CONTRACT PRICE or JOB COST means the actual or estimated dollaz amount chazged for the permitted <br /> work including materials, labor, profit, and other fixed costs. It is the amount to be chazged to the <br /> - customer for the work done. If any material, equipment, labor,or installation aze 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 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 � Y <br /> and correct. � . <br /> licant's Si ture: /�t �//Ur Date• �— � <br /> APP � � <br /> Approved By: J r Date: �� i� � <br />