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♦ <br /> . <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 /> 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 underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) , <br /> /�QQ Q x .0125 $ �� <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. ,/(�, OGG x .0005 $ g .• <br /> ,. <br /> or $.50, whichever is greater (contract price) <br /> 3. Postage and Handling (Only mail-in applications) $ 1.5 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �/(00 -- <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> \slerk �rinliw,�ine mate:ia?s, ?abo:, p:�fit, ar.d oth,: rxed cos�s. It is the amcunt :o be charged ta t::e <br /> customer for the work done. If any material, equipment, labor, or installation aze furnished by the owner, <br /> tenant or any other party the reasonah,le market value of such items must be added to the estimated cost <br /> or contract price for pernut fee purposes. In the event that there is a dispute on the amount of the job cost, <br /> i <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 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 th dinances of the City and the regulations of the Minnesota <br /> State Building Code, and ce ' es 11 statements made on this application are complete, true <br /> and correct. <br /> Applicant's Signa e: Date: �'J�'Q � <br /> Approved By: Date: <br /> -� ( n��c - P ; 1/•9 C - ��'o� �f�' `�ri�� <br /> /��'r � �1 /� r �� <br /> � <br /> C.'�� Qr���z� �� �3/y S� �'>�j /yo�" <br />