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. . �� • <br /> f , <br /> WOOD BURNING EOUIPMENT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> � �� Factory fireplace with flue <br /> Factory Fireplace (s) Freestanding Masonry <br /> Wood Stoy;� (s) Franklin, other <br /> Brand Name -�-��t,�,�-,�'� �,4`��� Model No. !-S��✓ ��-;�t�3.�- <br /> Mfgr's Min., Clearances, side .-.--.�,- rear �_ �� —, min. flue dia. 7-� ,.�,� <br /> ,� "c.:Le-arr-���.� <br /> : <br /> VENTILATION ..�-� • ".s:�-c�.F,�,v-�� <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <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 /> s /��_ e`�� X .oi2s $ l� �/ �� <br /> (contract price) <br /> 2. State Surchar� ** Add the State Building�code Division S_,7 <br /> Surcharge to each permit. �j S� � x .0005 $ �6 <br /> or $.50, whichever is greater (contract price) <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ � �b�f� <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 fumished 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 permit fee purposes. In the event that there is a dispute on the amount of the job cost, <br /> the City may request tne submission or'a signeci 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 <br /> all work in strict accordance with the ordinances of the City and the regulations of the Minnesota <br /> State Building Code, and e ifies that all stateme made on this application are complete, true <br /> and correct. � <br /> , <br /> Applicant's Signature: �� � � Date: ��� <br /> Approved By: Date: <br />