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� <br /> WOOD BURNING EOUIP1�fEI�"T <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 <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> Na. Qt�':�r F•ans: i.,o:,at:�:is cfm. <br /> Total <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 /> PERMI'I' FEE C�.I.C[TLATIt?i`� <br /> 1. 1.25% of Contract Price* or �finimum Fee ($35.00) <br /> )�j 7 5 x .0125 $ ;.::� c��� <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ , �:,� <br /> (contract price) <br /> or $.50, whichever is greater <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ � � ,�� �; <br /> � CONTRACT PRiCE or 30B COS[means t�.e ac�uai or estimateci doiiar amount charged for the permitted <br /> work including materials, labor, pmfit, and other fued costs. It is the amount to be 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 Ciry 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 e that all statements made on this application aze complete, true <br /> and correct. <br /> Applicant's Signature: '� Date: `.� ��-� ` <br /> Approved By: 1� � Date:�j 'iA $ <br />