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5-14-1998 1�_ 11A�1 FR0�1 FIRESIDE CORNER 612 633 888d p_ 3 <br /> '�'G'QOD BURNING E UIP'ME?!'T <br /> VVood stove with flue ' <br /> DJood combination or add-on <br /> Factory fucplace with flue <br /> Factory Fireplace (s) Freestanding Masoriry <br /> Wood Stove (s) Franl:Iin, other <br /> Brand Tame ModeI No. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> Total <br /> ' �'ENTILATION <br /> No. Kitchen Exhaust ducted recirculatin� cfm <br /> No. Bath Exbaust (muse be ducted ouuide) �{�; <br /> , No. Other Faac: Lacacions cfm <br /> TotaZ <br /> FUEL STOR.AGF (MUST BE APPROVED BY FIRE MARSHAL) <br /> Inszallauon Removal <br /> Fuel oi�: gallous underground 'znside outside <br /> J�.P Gas: galloas <br /> Other Gas openina <br /> PERMZ'X' FEE CALCULATIOA' <br /> l. ].25 io of Conrract Yrice'� or Minimum Fee l$35.(10) <br /> ��Co.o� x .4I25 � ,3_�,a J <br /> (contract pricc) <br /> 2. �ca.ce Surchar�e. ** Add the Srate Bui�d'zng Code Divisio�z <br /> Swrcharae to each peimit. x .00p5 $ �, ��-� <br /> (coaa-au prire) - _ <br /> or �.50, whichever is a eaEer <br /> 3. Posratre and HandIing (Only mail-i.n applicacions} � --� <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ;��. ��� <br /> "` COI�irRACT PRTCE or JOB CpST means the accual or estimaced dollar amount chareed for the permitted <br /> � work including materials, Iabor, profit, and othrs fixed eosu. It is �1ie amoun[ to be ctiazgcd to the <br /> cuscomer for�he wozk done. If any matzriai, �quipruent, labor,or insiatlation arc fumishcd by Lhe owner, <br /> tenaat or any oiI]�r parry the reasonable market valve of such items must be added to the estimated cost <br /> or contraa pricc for permit fee putposes. In the event�hat chere is a dispute on the amoant of tbe job cost, <br /> the Ciry may requcn chc subu3ission of a sidned copy of the actual conzract, <br /> *" Tbe STATE SURCHARGE is .0005 of the contnct price unsicr S1,000,000 or 5.50 - whichever is <br /> greater. For valuanoas o�er 51,000,000 call the Depa:zment of Iaspectional Services for the price. <br /> The undezszgzaed hereby applies to the City for issuance of a Mechanical Permit, agrees to do <br /> all work in stricc acc�r�ance with the ordinances o�t�Ze Ciry and the re�ulatzons of the Minnesot.a <br /> State Buildin; Code, az�d cenifies that aIl sratements made on this applicazion are complete, true <br /> and correct. <br /> AFPIicant'sSignamre: _ �/f,�,�,�, �-��� Date� 9� _ <br /> Approved By. Date: <br />