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a <br /> �'�'OOD BURNING EQUIPMENT � <br /> Wocxi 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 h�r,��i r�� Model No. /��a��x= <br /> Mfgr's Min., Clearances, side `�, rear � '' , min. flue dia. <br /> Total <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> �'p, BaCYl 'L"?C?]al2.SL (r�ust he ducted outside) rfm <br /> No. Other Fans: Locations cfm <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 /��5��� <br /> 1. 1.25%o of Contract Price* or Minimum Fee ($35.00) <br /> t1 � 5�, c:>o x .0125 $ �S� Qo <br /> (contract price) � <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. j I �S�c)G x .0005 $ � 5��� <br /> (contract price) <br /> or $.50, whichever is greater <br /> 3. Posta�ye and HandlinQ (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �7.C�g <br /> �` CONI'RfiCT �RICE or JOS LOST means the acti:al or estimated cloilar ar.:ounc i::�urged for the perm.itted <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 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 /> �� , / /,, , <br /> , (, , <br /> Applicant's Signature: � l,(�L�Y (�" ` ^ i L Date: ? � ��' <br /> Approved By: Date: <br />