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.-. - <br /> WOOD BURNING EQUIPMENT 6� p f'��� <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue <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 /> Total <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. ,,Z Bath Exhaust (must be ducted outside) �_ cfm <br /> No. Gther Far�s: Locations cfm <br /> Total <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 /> PERI�ZIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) � <br /> � �,{�� �, x .0125 $ �v��r 'J � <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division � <br /> Surcharge to each permit. ; `�� ���. x .0005 $ 7' �� <br /> (contract price) <br /> or $.50, whichever is greater / �J� <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ --}��' <br /> 4. TOTAL PERNIIT FEE (Add lines 1-3 above) $ <br /> * CONTRACT FRICE or.iGB COST means t��::,ac+��al or estimate� dollar amount char��o�t�ie�pefmitted <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 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 /> the City 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 Inspectionai Services for the price. <br /> T'he 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 statements made on this application are complete, true <br /> and conect. � � • <br /> Applicant's Signature: �� <br /> � �Cit� Date:/ <br /> ��,�-� -�. �_ �-���� <br /> Approved By: � Date: , <br /> � � <br />