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, � . <br /> , <br /> WOOD BURNIl�IG E�OUIPMENT <br /> Wood 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., Clearances, side , rear , min. flue dia. <br /> VENTILATION <br /> No. � Kitchen Exhaust � ducted recirculating cfm <br /> No. �_ Bath Exhaust (must be ducted outside) � cfm <br /> No. Other Fans: Locations cfm <br /> � - 1lAn1EC /�'.�' -•� f�.ir'� G/�C��0.�}qQ,r I <br /> FUEL STGRAGE (MUST BE APPROVED BY FIRE MARSHAL) ! <br /> Installation Removal � <br /> Fuel oil: gallons underground inside outside j <br /> LP Gas: gallons ', <br /> Other T e �5 __��__ Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) � <br /> e2, oao."� X .o12s � <br /> (contract price) <br /> 2. State Surchar�e. "* Add the State Building Code Division �� <br /> Surcharge to each permit. x ,0005 $ _��_ <br /> or $.50, whichever is greater (contract price) ; <br /> 3. Posta�e and Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAi, PERMIT FEE (Add lines 1-3 above) $ SO <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount chazged for the pemutted <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 furnished by the owner, ' <br /> tenant or any other party the reasunable mai•ket vaiue ef such items must be added to the estimated cost <br /> or contract price for pemut 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 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 o e Ciry and the regulations of the Minnesota <br /> State Building Code, and c ' ies that all state e ts ade on this application are complete, true <br /> and correct. <br /> Applicant's Signature: ` Date: � � `j <br /> A roved B � ��j (� <br /> PP Y� Date: <br />