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6 <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 /> � <br /> � Wood Stove (s) Franklin, other r <br /> Brand Name r���� �. �� '�. C,c•�i�'��u,c,�� Model No.��a H�A;�, t' /�;,�, <br /> Mfgr's Min., Clearances, side ��, re (�. , min. flue dia. � �` <br /> ;; <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath E�aust (must be ducted outside) cfin <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 /> �`>>�(^G , c G x .0125 $ �J,0� <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ <br /> or $.50, whichever is greater (contract price) <br /> 3. Postage and Handling (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 dollaz amount charged for the 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 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 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 Inspectionai Services for the price. <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do <br /> 1�'� 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 statements made on this application are complete, true <br /> \ and correct. � __ <br /> �' Applicant's Signature: Date: �l-2 - `I `I <br /> ` � <br /> Approved By: — Date: � -L--4 `� <br />