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, <br /> WOOD BURNING EQUIPMENT -� <br /> Wood stove with flue � <br /> Wood combination or add-on <br /> Factory fueplace 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 , mi.n. flue dia. <br /> Total <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating �� <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> IVo. Other Fans: I.:�catio�s �� � <br /> . Total <br /> F'UEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground i.nside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. �.25% of Contract Price* or Minimum Fee ($35.00) S�, <br /> 7G�C�1"-'- x .0125 $ ��' � <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division ��z <br /> Surcharge to each permit. x .0005 $ <br /> (contract price) <br /> or $.50, whichever is greater �-- <br /> 3. PostaQe and Handlina (Only mail-in applications) $ � <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) � �7j -� <br /> * CONTRACT PRICE or JOB COST means tue ac�ual or estimated dolla:a�o�t C.�:S�aL fpr thP rP17n3�� <br /> work including materials, labor, profit, and other fued costs. It is the amount to be charged to the <br /> customer for the work done. If any ma�erial, equipment, labor, or installation are furnished bY the owner, <br /> tenant or any other parry the reasonable market value of such items must be added to the estimated cost <br /> or contract price for perm.i[fee purposes. In the event thai 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,Q00,000 or $.50 - wfuchever is <br /> greater. For valuations over $1,000>000 ca11 the DePartment of Inspectional $ervices 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 tb.e City and the reguiations of the Minnesota <br /> State Building Code, and ce 'fies th�t all statem made on this application are complete, true <br /> and correct - - � ' ' . <br /> _ ,_ . . _ -. �_- : / �r ',,-�� Date: � // , <br /> _ Applicant's Signatur�: <br /> � -- Date: <br /> Approved By:- �� '. <br />