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. 2 <br /> WOOD BURNPIG EQUIPMENT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue <br /> Factory Fireplace (s) Freestanding Masonry <br /> Rlood Stove (s) Franklin, other <br /> Brand Name Model No. <br /> Mfo's Min., Clearances, side , rear , min. flue dia. <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 /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> a <br /> PERMTT F'EE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($3�.00) <br /> /��e�; x .0125 $ �S� cl� <br /> (contract price) <br /> 2. State SurcharQe. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ i 5 L <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handlina (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 3 "7, 0 G <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> work including materials, labor, profit, and other fixed costs. It is che amount to be charged to the <br /> customer for the work done. If any material, equipment, Iabor, or instaliation are furnished by the owner, <br /> tenant or any o[her party the reasonable market value of such items must 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 /> che City may request the submission of a signed copy of che actual contract. <br /> ** The STATE SURCHARGE is .0005 of the contract price under S1,000,000 or 5.50 - whichever is <br /> sreater. 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 reb lations of the Mi.nnesota <br /> State Building Code, and certifies that all statements made on this application are complete, true <br /> and correct. <br /> Applicant's Si;nature: Date: �� ��o <br /> A roved B : , Date: -- � ' ��Q <br /> PP Y <br />