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� . <br /> WOOD BURNING EQUIPMENT <br /> Wood stove wi flue <br /> Wood com ' ation or add-on <br /> Factory 'replace with flue <br /> Fact Fireplace (s) Freestanding Masonry <br /> od Stove (s) Franklin, other <br /> Bran ame Model No. <br /> r's Min., Clearances, side , rear , min. flue dia. <br /> VENTILATION }�� <br /> No. � Kitchen Exhaust �ducted recirculatin 3b0 cfm �r-� <br /> No.�_ Bath Exhaust (must be ducted outside) �-�fm -°�'�`-�� <br /> No. Other Fans: Locations cfm <br /> ;. <br /> FUEL STORAGE (MU RE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fue il: gallons underground inside outside <br /> Gas: gallons <br /> Other Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) � -� <br /> Z�, ��p�`��' x .0125 $ � � C; <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building C'ode Division <br /> Surcharge to each pertnit. x .0005 $ y . �# � <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ I__�_�(��1 ,,� <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 furnished by the owner, <br /> tenant or ar►y orher party thc reasonable mzrket value of su�h 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 S"I'ATE 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 appli�s to the City for issuance of a Mechanical Permit, agrees to do <br /> all work in strict acc�r�ance 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 Signatu : ���\4..,�.�- Date: <br /> A roved By: �,� Date: /Z-�� -`�� <br /> PP <br />