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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 �(�v��� <br /> No. _� Kitchen Exhaust ductecl recirculating ��cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. �_ Other Fans: Locations C//'�j✓G—L�/�✓� a�e'a �'9 cfm <br /> �/,�7��TY ,�erlra'I 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 /> �,;7y��� <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($�5.00) , <br /> ��,�r�; c:ti x .0125 $ Q(,� - Cs� <br /> (contract price) <br /> 2. State Surchar�, ** Add the State Building Code Division . <br /> Surcharge to each permit. �(IOU � 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) $ Lv � � C <br /> * COivTRr1LT FRICE ur JGB C�ST�e�,s ti-.�ac�u� cr estir.�ated dolla.*amc�wnt char�ed fer rhe permitted <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 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 Inspectionat 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 ce ' at all statements on this a plication are complete, true <br /> and conect. " � <br /> A licant's Signatur : 6 Date: ����!� <br /> PP <br /> 77? , i ' 1 � c' <br /> , - <br /> Approved By: � � �; Date: `� � <br /> � <br />