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, � � <br /> WOOD BURNING EOLT�MENT �. <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 �� <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 y� <br /> . , <br /> _ ; <br /> PERMIT FEE CALCULATION �� <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> ,,�_S� x .0125 $ -3� � <br /> < <br /> ):J <br /> (contract price) , <br /> � 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ /-;�� <br /> or $.50, whichever is greater (contract price) <br /> , <br /> 3. Posta4e and Handlin� (Only mail-in applicafions) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ;'�f7. 7�� <br /> �� <br /> * CONTRACT PRICE or JOB COST means the actual or estirnated dollar amount charged for the permitted v <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 mazket 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 conuact 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�that all statements made on this application are complete, true <br /> and conect. � � <br /> Applicant's Signature. �� . Date: � � ��`�'� <br /> Approved By: Date: <br />