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r <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 j <br /> � S v I^�-.n�.�.f l• �i` �c u� �..it-�_,,�t.�: . � - ���.. '�',� /�.t;_ �X � G'1�:,..,�a� <br /> FUEL STURAGE (MUST �3E 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 Mi 'mum Fee 35.00 <br /> 1 � U��3t;� �'� x .0125 $ I �j 1� :��� <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. �I , �e�� .•`�' x .0005 $ S� J 6 <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 1�/`�� `:�� <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 are furnished by the owner, <br /> le.^.Firit OP :I:)' Qtner party th;; :Q�St;lla'�i� i:di��2i �ailii; �r Si1Cll 1lt;TIlS i1;USi �y u�U�.� [O t.le £S:imated COSI <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 S"I'ATE 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 applics to the City for issuance of a Mechanical Permit, agrees to do <br /> all work in strict accurdance 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 cornplete, true <br /> and correct. / <br /> ✓ ��Applicant's Signature: - � Date: � <br /> Approved By: Date: L nJ � <br /> �i <br /> � <br />