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r + <br /> WOOD BURNING EQUIPMENT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue <br /> Factory I'ireplace (s) Freestanding Masonry <br /> Wood Stove (s) Franklin, other <br /> I3rand Naine Model No. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> V�NTILATION <br /> No. 1 Kitchen Exhaust x ducted recirculating cfm <br /> No. 5 I3at11 Exhaust (must be ducted outside) cfm <br /> No. 1 Other Fans: Locations Dryer ___ _ __ cftn <br /> FU�L STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Puel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> PERMIT F�� CALCULATION <br /> 1. 1.25% of Contract Price* or Minimu►n Fee ($35.00) <br /> $8,100.00 x .0125 $ 101.25 <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcilarge to each permit. $8,100.0o x .0005 $ 4.05 <br /> or $.50, whicllever is greater (contracc price) <br /> 3. Posta�e and IIandlin� (Only mail-in applications) $ L50 _ <br /> 4. 'I'O"I'AL PI�RMIT PET (Add lines 1-3 above) $ 106.80 <br /> * CONTRACT PRICE or JOB COST mcans thc actual or estimated dollar amount chargcd for thc permittcd <br /> work including materials, labor, profit, and other fixed costs. It is the amount to be charged to thc <br /> customer for the work done. If any ii::iterial, equipment. labor, or installation arc furnishe�by the own�r, <br /> tcnant or any other party the reasonable markct valuc of sudl items mus[ be added to the esticnited cost <br /> or contract price for permit fee purposcs. In thc event that there is a dispute on the amount of thc job cost, <br /> the City may request the submission of a signed copy of the actual contract. <br /> ** Thc STnTE SURCHARGE is .0005 of thc contract price undcr $1,000,000 or $.50 - whichcvcr is <br /> grcater. For valuations over $1,000,000 call the Department of Inspectional Scrviccs for thc pricc. <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 state ents made on this application are complete, true <br /> and correct. <br /> Applicant's Signature: llate: <br /> �lpproved By: Date: /Z - S " ' � <br />