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, � <br /> .- � <br /> . <br /> � <br /> I <br /> P <br /> WOOD BURNING 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 Min., Clearances, side , rear , min. flue dia. <br /> c_ � f )///J//�/ I <br /> �J � e��/L/'i"./L B I <br /> -..�n.—�� <br /> VENTILAT N� - <br /> No. Kitchen Exhaust ducted recirculating cfm � <br /> No. _� Bath Exha.ust (must be ducted outside) s'f� cfm <br /> No. Other Fans: Locations cfm <br /> ; <br /> FUEL STO�AGE (MUST RE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other - Gas opening <br /> PERNIIT FEE CALCULATION <br />� 1. 1.25% of Contract Price* or Minimum Fee ($35.001 <br /> � �p0 x .0125 $ ' <br /> z(contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ <br /> or $.50, which�ver is greater (contract price) <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ <br /> �° CONTRACT PRICE or JOB CO5T 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 pazty 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 Ciry 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. Eor valuations over $1,000,000 call the Department of Inspectional Services for the price. <br /> The undersigned hereby appl i�� to the City for issuance of a Mechanical Permit, agrees to do <br /> all work in strict accur�ance with the ordinances of the City and the regulations of the Minnesota. <br /> State Building Code, and certities that all statements made on this application are complete, true <br /> and correct. <br /> Applicant's Signature: P c Date: � � � <br /> Approved By: Date: <br />