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, <br /> WOOD BURNI�IG EQUIPMENT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue <br /> Factory Fireplace (s) Freestandin� Masonry <br /> Wood Stove (s) Franklin, other <br /> Brand Name Model No. <br /> Mfb's Min., Clearances, side , 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 underjround inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> � <br /> PERMIT FEE CALCULATION <br /> l. 1.25% of Contract Price* or Minimum Fee ($35.00) / � r � <br /> �d�� x .0125 $ �O �Q <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. �� � x .0005 $ �• �s <br /> or $.50, whichever is greater (concrac� price) <br /> 3. Posta�e and Handlina (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 char�ed for the permitted <br /> work including materials, labor, profit, and other fized 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 ocher party the reasonable market value of such items must be added to the estimated cost <br /> or contract price for pemut 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 che accual contract. <br /> ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or 5.50 - whichever is <br /> ereater. For valuations over �1,000,000 call the Department of Inspectional Services for the price. <br /> The undersigned hereby applies to the Ciry 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 sta ts made on this application are complete, true <br /> and correct. � � <br /> , � �.� Date: ��l 6..�� <br /> Applicant s Sijnature: <br /> Approved By: Date: <br />