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_ � <br /> WOOD BURNING EOUIPMENT 'I <br /> Wood stove with flue <br /> Wood combination or add-on , <br /> Factory fireplace with flue ' <br /> Factory Fireplace (s) Freestan ing Masonry <br /> Wood Stove (s) ` F anklin, other <br /> Brand Name ' Model No. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> VENTILATION <br /> No. _j_ Kitchen Exhaust _� du�ted recirculating cfm <br /> No. �_ Bath Exhaust (must be ducted utside) {�_ cfm <br /> No. Other Fans: Locations cfm <br /> FUEL STORAGE (MUST BE APPROVED BY' F MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons i un erground inside outside <br /> LP Gas: gallons , <br /> Other Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum ee 35.00 <br /> y�o '�= x .0125 $ <br /> (contra t pri e) <br /> 2. State Surchar�e. ** Add the State Buildi�g de Division <br /> Surcharge to each permit. ' x .0005 $ <br /> or $.50, whichever is greater (contract pri e) <br /> 3. Postage and Handlin� (Only mail-in ap'plic tions) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 ab ve) $ <br /> * CONTRACT PRICE or JOB COST means the actu�l or stimated dollar amount charged for the pernutted <br /> work including materials, labor, profit, and other fi ed costs. It is the amount to be charged to the <br /> customer for the work done. If any material, equipmen , labor, or installation are furnished by the owner, <br /> tenant or any other party the reasonable mazket value f such items must be added to the estimated cost <br /> or contract price for pemut fee purposes. In the event at 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 De ment of Inspectional Services for the price. <br /> The undersigned hereby applies to the City for issu nce of a Mechanical Permit, agrees to clo <br /> all work in strict accordance with the ordinances of th City and the regulations of the Minnesota <br /> � State Building Code, and certifies that all statements ade on this application are complete, true <br /> and correct. <br /> Applicant's Signature: � Date: S/3/9% <br /> Approved By: � ' Date: v�a <br />