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. � > <br /> WOOD BURNING EQUIPMENT <br /> Wood stove with flue , <br /> Woocl combination or add-on <br /> � Pactory fireplace with flue <br /> I�actory Fireplace (s) Freestanding Masonry <br /> Wood Stove (s) Pranklin, other <br /> I3rand Name Model No. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> V�NTILATION <br /> No. Kitchen Exhaust ducted recirculating cftn <br /> Na. Bath Exhaust (musr be. ducted nul�ic��l cf'm <br /> No. Other Fans: Locations cfm <br /> FU�L STORAGE (MU5T BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> z <br /> PF,RMIT FE� CALCULATION <br /> 1. 1.25% of Contract Price* or Minimwn Fee ($35.00) <br /> 7��C�.a � x .0125 $ �-� 3 7� <br /> (contract price) ' <br /> 2. State Surcharge. ** Add the State Building Code Division � <br /> Surcharge to eacll permit. �5��� x .0005 $ t-`7S <br /> or $.50, wl�ichever is greater (contrac� price) <br /> 3. PostaQe and Handlin� (Only inail-in applications) $ 1.50 _ <br /> 4. '1'O'I'AL P�RMI"I' FEC (Adcl lincs 1-3 above) $ �f7 U� <br /> * CONTRACT PRICE or JOQ COST mcans thc actual or estimatcd dollar amount chargcd for thc��crmittcd <br /> work inctuding materials, iabor, j�rofi!, ancl odier fixed cosi.s. it i; ti�c aniounl ic� h� c��,:��gcu tii tlte <br /> customer for thc work done. If any material, equipment, labor, or installation are furnishcd by the owner, <br /> tenant or any othcr 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 oC the job cost, <br /> the City may request the submission of a signed copy of the actual contract. <br /> ** "nc� STnTE SURCIIARGG is .0005 of thc contract pricc undcr $1,000,000 or $.50 - whichcvcr is <br /> grcater. ror valua[ions ovcr $1,000,000 call thc Department of Inspectional Scrviccs for tl�c pricc. <br /> The unclersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do <br /> all work in sti-ict 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 /> Applicant's Signature: � - Date: ���l �l S <br /> � <br /> Approved F3y: Date: ° <br />