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WOOD BURNING EQUIPMENT <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 ( `� \� � � c � ��. � Mode1 No. °� <br /> Mfgr's Min., Clearance`s�side , rear , min. flue dia. <br /> Total _�� C��C. <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations �f� <br /> Total <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price�` or Ivlinimum Fee ($35.0�1 /,1 <br /> I , ! � ��- ����.�> x .0125 $ �� C.�� �� <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division �,F-- <br /> Surcharge to each permit. x .0005 $ ° �-J� <br /> (contract price) <br /> or $.50, whichever is greater <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ • �� <br /> * CONTRACT PRICE or JOB COST means the actuai or estimated doilar 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 aze fumished by the owner, <br /> tenant or any other party the reasonable market value of such 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 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 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 /> icant's Si nature �_ `�, . Date: �� <br /> Appl g <br /> Approved By: Date: <br /> �: <br />