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r i <br /> WOOD BURNING EOUIPMENT <br /> Wood stove with flue <br /> Wood combination or add-on ` <br /> _� Factory fireplace with�e i-��A�-�G�� ~'�'T`-� �p `� <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 /> r <br /> VENTILATION � <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Instailation 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 /> �.`E:� : o� x .0125 $ `7 3 .��� <br /> —ontract pnce) . <br /> � 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. �.�.�`'� � <br /> �>� x .0005 $ � ��`+ <br /> or $.50, whichever is greater (contract price) <br /> t <br /> 3. Posta�e and Handling (Only mail-in applicafions) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �-7�•S � <br /> * CONTRACT PRICE or JOB COST means the actual or estunated 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 are fumished by the owner, <br /> tenant or any other party the reasonab?e marke[ value of such items mu�t be added to the estimated cost <br /> or contract price for pemut fee purposes. In the event that there is a dispute on the amount of the job cost, <br /> � the Ciry 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 Ciry 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: 1 1 � S-� 9 <br /> � <br /> Approved By: Date: <br />