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� <br /> � <br /> WOOD BURNING EQUIPMENT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Pactory 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 /> V�NTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (rnust be ductcd outside) cfm <br /> No. Other Pans: Locations cfin <br /> I+U�L STORAG� (MUST nE APPROV�D �3Y FIRE MARSII�IL) <br /> Installation Removal <br /> Puel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> P�RMIT F�E CALCULATION <br /> 1. 1.25°Io of Contract Price* or Minimum Fee ($35.00) <br /> ���j ���'-,�';; ��r, x �.0125 $ � 5 �;, <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division „ , � <br /> Sui-char-ge to each permit. x .0005 $ �• ` S ` <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTf1L PERMIT FEE (Add lines 1-3 above) $ � � �S`�� <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> work including matcrials, labor, profit, and other fixed costs. It is the 8I110UI1I l0 be chargcd to the <br /> customer for thc work done. If any matcrial, equipment, labor, or installation are furnished by the owner, <br /> tenant or any other party the reasonable market value of such items �nust bc added ro thc estimated cost <br /> or contract price for pennit 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 /> ** "I'he STnTE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is <br /> grca[cr. For valuations over $1,000,000 call the Deparhnent of Inspectional Scrvices for the price. <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees ro do <br /> all work i�i strict accordatice with the ordinances of the City and the regulations of the Minnesota <br /> State Building Code, and certifies tliat all statements made on this a�plication are complete, true <br /> and correct. <br /> Applicant's Signature: � � �c ���'ii .�G� Date: �� �7 /� <br /> Approved By: — Date: �( �� �� <br />