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� � � <br /> t _ � <br /> _ _ .. . . --- <br /> WOOD BURNING EQUIPMENT - <br /> � Woad 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., Cleazances, side , rear , mi.n. flue dia. <br /> To#al <br /> 'VENTILATION <br /> No, Kitchen Exhaust ducted recirculati.ng cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No, Ot�er Fans: Locati�r.s �� <br /> . Total <br /> FUEL STORA.GE (MUST BE APPROVED BY FIRE MARSHAI-) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> I,p Gas: gallons <br /> Other Gas openi.ng <br /> PERNiIT FEE CALCULATION <br /> 1. 1.25% of Contract Price�` or iYIinimum Fe� (�35•�0) / <br /> � �, x .0125 $ � �� �`+ <br /> (contract rice) <br /> 2. State SurcharQe. ** Add the State Buildi.ng Code Division / <br /> Surcharge to each permit. ���� X •�5 $ r ' s--3 <br /> (c ntract price) <br /> or $.50, whichever is greater <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERNIIT FEE (Add lines 1-3 above) � � �� <br /> * GONTRr'�Ci'PRiCE o:JL'B CCST ae:.a� !he actual or esiinated dollar amount charged for the permitted -� <br /> work including materials, labor, profit, and other fiaed cosu. It is the amount to be chazged 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 valae 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 the submission of a signed copY of the actual contract- <br /> ** The STAT'E SURCHARGE is .0005 of the contract price under $1,000,000 or 5.50 - whichever is <br /> greaier. For valuations over$1,000,000 call che DePart�ent 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 certifies that all statements made on this application are complete, true <br /> and correct.-__._�._.___ <br />. . ___: .:_:._. :.: , , _ � � o � <br /> Applicant's Signature: ' Date: <br /> - Date: <br /> . Approved By:- : � , <br />