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Sep-01-98 09:47A Fireside Corner 651 633 8884 P.03 <br /> �'�'OOD BUR�!'LNG EQ tIP1'IE�"T <br /> Wood stove with flue " <br /> Wo�d combination or add-on <br /> Pactory ftreplace with flue <br /> Factary Fireplace (s) Freestanding Masonn� <br /> Wa�d Stove (s) Pranl:Iin, other <br /> Brand I`ame Model No. <br /> Mf�r's Iviin., Clearances, side , rear , min. flue dia. <br /> Totat <br /> �rE�'TILA TION <br /> No. �itchen E�aust ducted recirculatin� cfm <br /> No. Bath Exhaust (must be dvcted ouuide) cfm <br /> No. Uther Fans: L.acations cfm <br /> Toial <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MA�tSHAL) <br /> Installacion Remo�al <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas openin, <br /> PER3�iIT F'EE CALCULATION <br /> i. 1.2�i'o ofCantracc Price* or �4inimum Fee (�35.�0) <br /> 11(.�c?� x .41?5 � �'�.Go <br /> (contrac[ price) <br /> 2. State Surchar�e. ** Add the State Buildin� C�de Division <br /> Surcharge to each permit. //��� x .00�5 � •5 S <br /> (con�rac� pnce) <br /> or �.Sa, whichever is �reater <br /> 3. Postase and Handlino {pnly mail-in apptications) � � <br /> 4. TdTAL PERMIT FEE (Add Iines 1-3 above) � .�'�;.�� <br /> * COh7R.ACT PRICE o:JOB COST means tt�e actual or tstimated dollar amount chareed for the permi«ed <br /> wor}; includinc materials, labor, profit, and other fizeri costs. It is tbe amount to be charge,d [o the <br /> eustomer for the wor}:done. If an}�materiai, equipment, lahor, or iustallation are furnisheti b?�the owner, <br /> tenant or an�• other party the reasonable mar4:tt value of such itetns must be added [o the estmnaced cost <br /> or comracc price for peimit fee purp�ses. in the event that�here is a dispute on the amount of the job cost, <br /> the Cit}� may request the submission of a signed copy of the actual contract. <br /> ** Tht STA'I'E SURCHARGE is .0405 of the contract price under 51,OOQ,00� or SSO - wtis:l�ever is <br /> greace:. For valuations over 51,Q00,00�call the Department of Inspectional Sen�ices for the ptice. <br /> The undersi�ned hereby applies to ihe Gin� for issuance af a MechanicaI Perm.it, aQrees to do <br /> all urork in sLrict accordance ��ith the ordinances of the Cit�r and the rL�ulations of the Minnesota <br /> State Buildin; Code, and certifies that all statements made on this appli;.ation are camplete, true <br /> and carrect. <br /> i <br /> Applican.'s Si�nature: _T/�a����,� Date: � <br /> Approved By: Date: <br />