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_ � <br /> WOOD BURNING EOIT�MENT <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 Model No. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> VENTILATION � <br /> No. Kitchen E�aust ducted recirculating cfm I <br /> No. Bath Exhaust (must be ducted outside) cfm � <br /> No. Other Fans: Locations cfm ; <br /> � <br /> I <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 I <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> �c� , �'�' x .0125 $ <br /> (contract price) <br /> ' 2. State Surcharge. ** Add the State Building Code Division � <br /> Surcharge to each permit. x .0005 $ � <br /> or $.50, whichever is greater (contract price) <br /> t <br /> 3. Posta�e and Handlin� (Only mail-in applicafions) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 3.�-S� <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 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 /> Applicant's Signature: . Date: �` � /� � <br /> Approved By: Date: <br />