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WOOD BURNING E�QUIPMENT <br /> Wood stove with flue = <br /> Wood combination or add-on � <br /> Factory fireplace with flue <br /> � Factory Fireplace (s) Freesta ' ing Masonry <br /> Wood Stove (s) ' F'anklin, other � <br /> Brand Name Model No. <br /> Mfgr's Min., Clearances, side , re , min. flue dia. <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted utside) cfm <br /> No. Other Fans: Locations cfm <br /> } FUEL STORAGE (MUST BE APPROVED BY FI MARSHAL) <br /> Installation Removal �', <br /> Fuel oil: gallons ' un erground inside outside <br /> LP Gas: gallons <br /> � Other Gas opening <br /> � <br /> PERMIT FEE CALCULATION ' <br /> 1. 1.25% of Contract Price* or Minimum �`ee 35.00 <br /> � � � x .0125 $ �.�� a <br /> (contract pri e) <br /> 2. State Surcharge. "* Add the State Buildi g C de Division � <br /> Surcharge to each permit. /� �c� x .0005 $ . �5 <br /> or $.50, whichever is greater (contrac pric�,) _ <br /> 3. Posta�e and Handlin� (Only mail-in applic tions) $ 1.50 <br /> 4. TOTA� PERMIT FEE (Add lines 1-3,abo e) $ � 7 �,�"' <br /> r <br /> * CONTRACT PRICE or JOB COST means the actual or timated dollar amount charged for the permitted <br /> work including materials, labor, profit, and other fix d costs. It is the amount to be chazged 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 such items must be added to the estimated cost <br /> or contract price foc pemut fee purposes. In the event th t there is a dispute on the amount of the job cost, <br /> the City may request the submission of a signed copy f the actual contract. <br /> ** The STATE SURCHARGE is .0005 of the contract rice under $1,000,000 or $.50 - whichever is <br /> greater. For valuations over $1,000,000 call the Dep ment of Inspectional Services for the price. <br /> The undersigned hereby applies to the City for issua ce of a Mechanical Permit, agrees to do <br /> all work in strict accordance with the ordinances of the ity and the regulations of the Minnesota <br /> State Building Code, and certifies that all statement m de on this application are complete, true <br /> and conect. <br /> Applicant's Signature: � Date: � �- r� <br /> Approved By: I J Date: , � �� '�>' <br /> � ' <br />