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� <br /> � � <br /> WOOD BURNING EOIJIPMENT t <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 /> �I <br /> VENTILATION � =i <br /> No. Kitchen Exhaust ducted recirculating cfm ., <br /> No. Bath E�chaust (must be ducted outside) cfm <br /> No. I Other Fans: Locations !/� m�✓ �� cfm <br /> A-�i� �xchg-r��-j �' <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE IViARSHAL) <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) <br /> /Ud � x .0125 $ � � 70� <br /> . (contract price) , <br /> � 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ f-�,� <br /> or $.50, whichever is greater (contract price) <br /> � <br /> 3. Posta�e and Handling (Only mail-in applications) $ 1.50 <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 pernutted <br /> work including materiaIs, labor, profit, and other fixed costs. It is the amount to be chazged 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 mazket value of such items must be added to the estimated cost <br /> or contract price for pemut fee purpcses. In the event thai 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 conect. � <br /> Applicant's Signature:`--�/ � , Date: �� � l�v� <br /> � <br /> Approved By: Date: <br />