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�' � <br /> � <br /> �VOOD BtiR�Zti G EQLTIPI'1EN'T <br /> tiVood stove with flue <br /> �ood combination or add-on <br /> Factory fireplace with flue <br /> Factory Fireplace (s) Freestanding Masonry <br /> �ood Stove (s) Franklin, other <br /> Brand�tame Model No. <br /> 1�1f�r's ��1in., Clearances, side , rear , min. flue dia. <br /> VENTIL�TION <br /> No. Kitchen E�chaust ducted recirculatin; cfrn <br /> gatl1 i�ha;;;t (P-;us; be ducted outside) �� <br /> No. cfm <br /> No. Other Fans: Locations <br /> FLTEL STOR�GE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: �allons underground inside outside <br /> LP Gas: aallons <br /> Other v Gas opening <br /> PERMIT FEE CALCULATION 5� <br /> 1. 1.25% of Contract Price�` or Minimum Fee 3�.0� <br /> ,�f,y�l- �=-,; x .0?25 � <br /> (con[ract price) � <br /> 2. State Surcharae. ** Add the State Building Code Division L/r_ <br /> a Ch etITllt. X .�Q�J � �/ ' <br /> Surchar,e to ea p <br /> or 5.50, whichever is greater (contract pnce) <br /> 3, Postaae and Handlina (Only mail-i.n applications) � <br /> 1.50 <br /> 4, TOTAI. PERI�IIT FEE (Add lines 1-3 above) � _�� <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount cnarged for the permizted <br /> work inciudi;.� mater_�::s, '.abor, proft, a�d 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 iurnisned by the owner, <br /> tenant or any o[her party the reasonabie market value of such items must be added to the estimated cost <br /> or con�ract price for permit fee purposes. In the event that there is a dispute on the amount of the job cost, <br /> the City may reauest the submission of a signed copy of the acn�ai contract. <br /> ** The ST:�TE SURCHARGE is .000� oi the contract price under 51,000,000,or 5.50 - whichever is <br /> �reacer. For valuations over S1,000,000 call the Deparcmenc of Inspectional Services for the price. <br /> The undersianed hereby applies to the City for issuance of a Mechanical Permit, a�rees to do <br /> all work in strict accordance with the ordinances of the Ciry and the regulations of the Minnesota <br /> State Buildi.n� Code, and certifies that all statements made on this application are complete, true <br /> 1 � , , ,� <br /> and correct. �" • � <br /> G� � <br /> Applicanc's Sianature: _ Date: <br /> A roved By: Date: �� � <br /> PP <br />