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. _ . . i <br /> _ _ _ <br /> -- - _ ._ . - - <br /> _ WOOD BURNING EQUIPMENT . <br /> � Woo ove with flue <br /> Wood com ' tion or add-on ', -- . <br /> Factory fireplace ' � � <br /> - Factory Fireplace reestanding M��Y � <br /> Wood Stov cliu other <br /> Brand Name Model No. <br /> Mfgr's ., Clearances, side , rear , ' . flue dia. . <br /> To#al <br /> � ' . <br /> VENTILATION c� <br /> No. Kitchen ust d recirculati.ng <br /> No. Bath Exhaust (m ducted outsid ) �� <br /> No. Other F cations �� � <br /> + � <br /> To <br /> ` FUEL STORAGE (MUST APPROVED BY �-) <br /> ; Installation Re al <br /> Fuel oil: gall undergr nd inside outside <br /> LP Gas: allons � <br /> Other Gas opening <br /> pER�v1IT F'EE CALCULATION <br /> 1. 1.25% of Contract Price�` or �finimum r� °����� �' <br /> y�''���� X .oi2s $ ��1� <br /> (contract price <br /> ** Add the State Building Co�le ivision � <br /> 2. State SurcharQe. � ,�.� � <br /> Surcharge to each permit. ��lJ� I� X '0045 $ -� <br /> (concract pnce) <br /> or $.50, whichever is greater 1.50 <br /> 3. Posta�e and Handlin� (Only mail-in applications $ �� �� <br /> 4. TOTAL PERMIT FEE (Add li.nes 1-3 abov�e) <br /> ' * TRACI'PRICE or JOB COST means the actu�or e�tima ed dollar amounc cnarg�a zor tne perrinui <br /> CON <br /> work including materials, labor, profit, and o[her fixed cos . It is the amount to be chazged to e <br /> customer for the work done. If any ma�enal. e4�Pm�t, labo ,or installation are furnished bY the owner, <br /> tenant or any other parry the reasonable market value of such items must be added to the estimated cost <br /> or conu�act price for permic fee purposes. In the event that the is a disPute on the amount of the job cost, <br /> the City may request the submission of a signed coPY o€t�e tual ��- <br /> 'ce der $1,000,00� or S_50 - whichever is <br /> ** The STATE SURCHARGE is .0005 of ��e�D�P n of Inspectional Servic�s for the pr.ce. <br /> greater. For valuations over$1,000,000 <br /> The undersigned hereby applies to the City for issuan�e o 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 de n this application are complete, true <br /> , . <br /> and correct �-- - . <br /> - � " <br /> .._ _ _ _ -- -- - ����r <br /> _ � - Date: � <br /> _ Applicant's Signature' <br /> � _ _ �' Date: `7 -6 '9`� <br /> : . APProved By:��., _ . <br />