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__- WOOD BURNING EQUIPMENT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> I�acto�y f�ireplace with flue <br /> Factory Fireplace (s) Freestanc]ing Masonry <br /> Wood Stove (s) � Franklin, other <br /> Brand Name Model No. <br /> Mf r's Min., Clearances, side , rear , min. flue dia. <br /> � ' _ . . , , . <br /> �F�_�����I �' �i-S �;l `j �� �-�� `� (•���� � L`� •� � � c ?�.C� � L. <br /> V�NTILATIQ� �l � ' '�� <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) efm <br /> No. Other Fans: Locations cfm <br /> rU�L STORAUE (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 /> PCRMIT F�� CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum rce ($35.00) ` �_<' <br /> ��. � c.�� x .0125 $ ��� > <br /> (contract price) <br /> 2. 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. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. 'I'OTAL PLRMIT FI?� (�1dd lines 1-3 above) $ =��:`'—`y <br /> * CONTRACT PRICE or JOB COST mcans thc actual or estimatcd dollar amount chargcd for thc��cnnittcd <br /> �vork including materials, labor, profit, and other fixed costs. It is the amount to be charged to the <br /> customcr for the work done. If any material, cquipmen[, labor, or installation are furnished by Nle owner, <br /> tcnant or any other party the reasonable marke[ value of such items must be added ro thc estimated cost <br /> or contract price for permit fee pumoses. In the event that there is a dispute on dle amount of the job cost, <br /> thc Ciry may request the submission of a signed copy of the actual contract. <br /> ** The S"1'nTG SURCIInRGG is .0005 of thc contract price undet $1,000,000 or �.50 - whichever is <br /> greatcr. For valuations over $1,000,000 call the Departinent of Inspectional Scrvices 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 /> , � � "`/� �.�._� Date: /����--�� <br /> Applicant s Signature: - <br /> Approved By: Date: <br />