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� <br /> WOOD BURNING EQUIPMENT <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 Model No. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> Total <br /> VENTILATION jC''L'��L��cI� <br /> No. Kitchen Exhaust ductecl recirculating cfm <br /> No. Bath Exhaust (must be ducted out 'de) cfm <br /> No. �_ Other Fans: Locations �i' ,,�. ��D� _ �_-- �f _ ._ �/�j%� <br /> Total t7 �% G <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. 1.2�% of Contract Yrice* or Ntinimum Fee ($3�.a4) ,, <br /> �f��'`,(i('t��, `'�' x .0125 $ ,-��1� � _�� <br /> (contrac[ price) <br /> 2. State Surcharge. ** Add the State Building Code Division �U�� <br /> Surcharge to each permit. ''� ;�, :� J �` x .0005 $ <br /> (contract price) <br /> or $.50, whichever is greater <br /> 3. Posta�e and HandlinQ (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ -��� �•-S�% <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pemutted <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 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 conuact. <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 certi es that all statements made on this application are complete, true <br /> and conect. <br /> Applicant's Signature: � � Date: // � 6� <br /> ��� � �� ��� <br /> Approved By: Date: l l - � -c� <br />