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. � <br /> WOOD BL�RNING E�UIPNIEI�iT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue <br /> � Factory Fireplace (s) Freestanding Masonry <br /> Wood tove (s) Franklin, other <br /> Brand Name � Modei No. ���� <br /> Mfgr's Min., C earances, side , rear , min. flue dia. <br /> Total <br /> VENTILATION <br /> No. Kitchen E�aust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locatians cfm <br /> Total <br /> FL'EL 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 /> PERiV�lI�' FEE CALCIILATIOi'� <br /> 1. 1.25% of Contract Price* or Minimum Fee (�35.00) <br /> %:'QO .UO x 1.25 $ � — <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division ' �� <br /> Surchar�e to each permit. x .0005 $ <br /> (contract price) <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ - <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 he charged to the <br /> customer for the work done. If any material, equipment, labor, or installation are fumished 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, a certifies that all statements made on this application are complete, true <br /> and conect. <br /> � �Applicant's Signature: Date: � — <br /> Approved By: Date: <br />