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� <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 � 1'' -{-t��t- Model No. � � 1 <br /> Mfgr's Min., Clearances, side � Z" , rear ��2�`, min. flue dia. ��� <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (mu:�t be ducted outside) cfm <br /> No. Other Fans: Loca.tions cfm <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 /> l. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> 41�,�.c:�c� ' x .0125 $ ��� �� <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ ��[U <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 5 G��t� <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 Lhe w�rk dnne. If any material, equipment, labor, or installation are furnished by the owner, <br /> tenant or any other party the reasonable mazket value of such items must be added to the estimated cost <br /> or contract price for pemut 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 <br /> and conect. <br /> � � ' � ��'S. <br /> Applicant's Signature: G - ,�(Li,� Date: ���� <br /> � � <br /> Approved By: Date: <br />