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� Y <br /> � <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 /> Total <br /> VENTILATION <br /> No. Kitchen E�chaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations 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 /> � <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) - 'Z <br /> -.> � x .0125 $ 9% `�.�� ._ > <br /> ( ontrac[ price) <br /> 2. State Surcharge. ** Add the State Buildi Code Division <br /> Surchat•ge to each permit. � �'�� x .0005 $ �� � � C , <br /> (c�price) <br /> or $.50, whichever is greater <br /> 3. Postage and Handlin� (Only mail-in applications) $ -�'- <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ •� 2 <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar 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 aze 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 cuntract 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 Inspectional Services for the price. <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do �i <br /> all work in strict accordance with the ordinances of the City and the regulations of the Minnesota I <br /> State Building Code, and certifies that a�statements made 's application are complete, true <br /> and correct. ��� � <br /> i����, , , , ..- -�-- <br /> �.��� �� �-----�_. �- �� ��� i �� �� , � <br /> Applicant's Signature: � y Date: � <br /> Approved By: n U� Date:�!/ �� � <br /> � <br />