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3-30-1998 1 : 13P�1 FROr� FIRESIDE CORNER 612 633 888a P_ 3 <br /> . � <br /> II <br /> i <br /> A �URNING E U�tP1v�NT ��-�..�. (��- F/p _ �`,-,�/� �r�� <br /> ' Wood stovc with flue � <br /> �� Wood combination or add-on �'�� x�-T " ���� �7"Z.t i� <br /> ! Faccory fireplace with flue <br /> Factory Fireplace (s) Freestanding Masonry <br /> ! � Wood Stove (s) Franlclin, other <br /> � BrandNazz�e�c�zk�,..�� ModelNo. �,�� <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> j Total_ �2 �Fi�2� �'c_e . <br /> V� NTIL,A,TYON <br /> No. Kiichen Exhaust ducted recirculatinb c{m <br /> � No. Sat� Exhaust (must be ducted outside) cfm <br /> i No. Other Fans: Locatioris �� <br /> Total <br /> k'�JET. STORAGE (MUST BE APPRpVED BY F[12E MARSHAL) <br /> I Inszallacion Remova� <br /> �� Fuel oil: gal�ons underground inside outside <br /> ' LP Gas: <br /> ; gallons <br /> ; Other Gas opexazng <br /> , <br /> P�RMIT FEE CALCiJLATZON <br /> 1.! 1.25% of�oncra�c Price* or Minunum Fee ($35.40) <br /> � a����.c_x� x 1.25 � .a�.o <br /> i p <br /> ' (tontract price) <br /> 2.� Stace Stuchar��. ** Add the State Bailding Code Division <br /> Surcharge to each permit. x .0005 $ /. �p <br /> � (conuact price) <br /> � 7nr� N t,ril;.,r. '�+�#�-�'a� �� a'�Y�C�t'!e'�sT m----�-j�— <br /> 4.i TOTAL PERMTT FEE (Add lines I-3 above) � �(�,, �� <br /> ; * CON7RACT PRICE or JO$COST means the accual or estimaced doIlar amount charged for the permit�ed <br /> ! work including macezials, tabor, graftc, and o[h�r fixed costs. It is rhe amount to be charged to the <br /> cuscomer for the work done. If any material, equipment, labor, or installacion are fiunishcd by the owner, <br /> � tenan� or an ocber <br /> y parry che reasonable m3rkec va(ue of such items must be added to ehe estimaced cost <br /> j or cantract price for permit fce purposes. In the event that there is a dispute on the amounc of the job cost, <br /> i the Ciry may request the subzaission of a signed copy of the acma� contract. <br /> i <br /> ; "'* 'Ibe STATE SURCHARGE is .0005 of the coniract price nnder $1,000,000 or $.50 - which�v�r is <br /> � greater. For vaivatioas over S2,ppp,ppp catl the Departmeat of TaspectionaI Scrviccs for the price. <br /> i <br /> Tl�e undersigrxed bereby applics to the City for issuance of a Mechanical Fezzn,it, agrees to do <br /> a11!work in mict accordance with the ordinances of the Ciry and ihe regulations of the Minnesota <br /> State Building Code, and cercifies that all statemencs made on this appIication are concxplete, true <br /> and conect. <br /> i <br /> , <br /> A�plicanc'sSigz�ature:�_ ��, �.��y� Dace_ _3 � c 9� <br /> � <br /> A�proved By: Date: <br /> i <br />