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. <br /> WOOD BURNING EOUIPMENT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> _L Factory fireplace with flue <br /> Factory Fireplace (s) Freestanding Masonry <br /> Wood Stove (s) Franklin, other <br /> Brand Name j'��:�,+.y.�,.;� Model No. `�,�% ° ` <br /> Mf r's Min., Cleara ces side �� <br /> g , , rear , min. flue dia. <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations 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 /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> �--'�-�' ��'-�k--- X .�12$ $ `; 1� UG� <br /> �..�_. <br /> (contract price) �� , <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. j��c� x .0005 $ �,- '-> <br /> , <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) $ ; �� , ��, <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 the work done. If any material, equipment, labor, or installation are furnished by the owner, <br /> tenant or any other purty the reasunable market value of such items musi be adcied to the estimated cost <br /> or contract price for pernut 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 �1,00O,OOU 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 s <br /> and correct. <br /> Applicant's Signature: � �_ ��;���� d�' ` Date: / <br /> 4 <br /> Approved By: Date: " <br /> � <br />