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t <br /> . <br /> WOOD BURNING EQUIPMENT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue <br /> � Factory Fireplace (s)�;�-S� Freestanding � Masonry <br /> Wood Stov (s), Franklin, other <br /> Brand Name a � �-�� L;� Model No. j�v !� 3 (c� <br /> Mfgr's Min., Clearance , side �i�, rear ( " , min. flue dia. <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. � Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <br /> FL��L 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 Minimum Fee ($35.00) ,; ._� r,,._�.q <br /> � x .0125 $ '�} � � .-�� <br /> contract price} <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. ���"; x .0005 $ � , � <br /> or $.50, whichever is greater �eract price) <br /> 3. Postage and Handlin� (Only mail-in applications) $ �-- <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ <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 any other party the reasonable market value of such items must be added to the estimated cost <br /> or contract price for pernut 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 /> Applicant's Signature: Date: tl t � � <br /> Approved By: , p�� Date: �I� i Z �C'1�j <br />