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3-03-1995 11 =58PF-1 FROR1 FIRESIDE CORNER 612 633 888d P_ 3 <br /> , <br /> WOOD BUR.NING EOLT���TT' <br /> Wood sto�ve with flue <br /> Wood combina.tion or add-on <br /> Factory fireplace with flue <br /> �--�actory Fireplacc (s) Freestanding Masonry <br /> Wood Stove (s} Frankiin, other <br /> Brand Name �o;,t ,�1 (�r r, Model No. �.,rn�,X�.S <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> Totai <br /> VENTILATION <br /> No. Kitchen Exhaust ducted rec�rculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fazzs: Locat�ons cfrn <br /> � TotaI <br /> k'UE�, STOR.AGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Insta.11ation Removai <br /> FueI oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas openiug <br /> PERMIT FEE CALCULATION _ <br /> 1. 1.25% of Contract Price�` or 1Vlinim�um Fee l�35.00) <br /> x .0125 � a��o� <br /> (comract price) <br /> 2. State Surchar�e. ** Add the Staie Building Code Divis9on <br /> Surcharge to each permit. x .0005 � �SS' <br /> {concract pricc) <br /> or $.Sd, whichever is greater <br /> 3. Posta�e and Handl�,� (Only mail-in applications} $ 1_50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �.�?.�� <br /> * CONTRACT PRICE or 30B COST means the aczual or�stimat�d dollar amouuc charged for cbe p�r,mitted <br /> work including xnacerials, labor, profit, aad other fued costa. It is the amount to be charged to chc <br /> customer for the work done. If any material, equipment, Iabor, or iastalla�ion are furaished by the owner, <br /> tenant or any other pazty the reasonable market value of s�ch iums must be added co che estimated cost <br /> or contract pac�for permit fee purposes. In the evenc thac these is a dispuc�on�h�araoun�pf chc job cost, <br /> the Ciry may zequest tbe submissioa of a sigaed oopy of the accuai eoncraet. <br /> "`* The STA?E SURCHARGE is .0005 of th� eontraet price under 51,000,000 or $.SO - whichever is <br /> greater. For valuatioas over Si3Opp.ppp c�il the Deparsment of Iacpectional Services for ch�price. <br /> The undersigned hereby applies to the Ciry for issuance of a Mechanical Permit, agrees to do <br /> aII work im suict accordance�cvith the ozdinances of ihe City and the�cegulatxo�as of the Miaxzxesota <br /> State Buildiung Code, and cenifies that aIl statemenrs made on th.is application are complete, an�e <br /> and correct. <br /> Applicant'sSign,a.ture�, �,�.,, � - Date: 9 t- <br /> _��� <br /> Approved By: Date: <br />