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, <br /> _ WOOD BURNING EQLTIPMENT -- - <br /> � Wood stove with flue � <br /> . � - . Wood combination or add-on : ._ <br /> Factory fireplace with flue � � � <br /> - Factory Fireplace (s) Freestanding _ Masanry � <br /> � Wood Stove (s) Franklin, other � <br /> Brand Name Model No. <br /> Mfgr's Min., Clearances, side , rear , mi.n. flue dia. <br /> Ta#al <br /> VENTILATION <br /> �No. Kitchen Exhaust ducted recirculati.ng �� <br /> No, Bath Exhaust (must be ducted outside) �� � <br /> No, Other Fans: Locations �� � <br /> Total <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> L,p G�; gallons <br /> Other Gas opening <br /> PERMIT 1+EE CALCULATION <br /> l. 1.25%o of Contract Price'� or iviinimuiri ��ee (�3�•QO <br /> jf --� ? '�. � X .�125 � �-��� � ���� - <br /> (contract price) <br /> 2. State Surr.har�e. ** Add the State Building Code Division ,, , , , <br /> Surcharge to each permit. �_� ��<< �_\ �- x .0005 $ � ` <br /> (contract price) <br /> � or $.50, whichever is greater $ 1.50 <br /> 3. Posta�e and HandlinQ (Only mail-in applications) $ / , <br /> 4. TOTAL PERNIIT FEE (Add li.nes 1-3 above) / - <br /> * CONTRACT PRICE or JOB COST means the acrual or estimated dollar amount charged for the permitted <br /> work including materials, labor, profit, and other fiuced costs. It is the amounc to be charged to the <br /> cuscomer for the work done. If any mate.^:al, equipment, labor, or installation are fum�hed bY the owner, <br /> � tenan[ or any other party the reasonable market value of such items must be added to che estimated cost <br /> or contract price for permit fee purposes. In che 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 contra�t• <br /> ** The STATE SURCHARGE is .0005 of [he contract price under $1,OOO,Q00 or $.50 - whichever is <br /> greater. For valua[ions over $1,000,000 �all �e DePartment of Inspectional Services for the price. <br /> The undersigned hereby applies to the City for issuance of a Mecha.nical Permit, agrees to do <br /> all work in strict accordance with the ordinances of the City and�e ����o�i�eso�e <br /> State Buildi.ng Code, and certifies that all statements made on this app P <br /> _ and correct .-- -- ` ._ _ � . /�'� <br /> � _ � � . � - : . ....�:�: � �� , �� _� � .� �� � A ` Date: �� � � <br /> _ Applicant's Signature' ' <br /> . � - Date: 1� �o <br /> � A roved B . �` ' <br /> PP y;:. _�., <br />