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S� � 4 <br /> I <br /> WOQD BURNING EOUIPMENT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue <br /> Factory Fireplace (s) Freestanding MaSonry <br /> Woad Stove (s) Franklin, other <br /> Brand Name Model No. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath E�aust (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: gallans underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> P�RMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) � <br /> x .0125 $ � <br /> � ,��'`z' � l� <br /> . . (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division '� �� <br /> Surcharge to each permit. x .0005 $ <br /> or $.50, whichever is greater (contract price) <br /> 3. Postage and Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ � ��, -�f 8 <br /> �, <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pemutted <br /> work including materials, labor, profit, and ather fixed costs. It is the amount to be charged to the <br /> :.ustoiner for ihe work done. If any materiai, equiFment, labor, or installation are rurnished by the owner, <br /> tenant or any other party the reasonable market value of such i[ems must be added to the estimated cost <br /> or cantract price for permit fee purposes. In the event that there is a dispute on the amount of the job cost, <br /> the City may request the submissian of a signed copy of the actual contract. <br /> ** The STATE SURCHARGE is .0005 of the contract price under $1,OOO,U00 or $.50 - whichever is <br /> greater. For valuations over $i3Od0,OQ0 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 Ciry and the regulations of the Minnesota <br /> State Building Code, and cert ies that all statemen ade on this application are complete, true <br /> and carrect. <br /> , <br /> Applicant's Signature: <�^ Date: �" 3�-U_5 <br /> Approved By: Date: <br /> �, <br /> � <br /> `, <br /> �,,� .. x: <br /> �.:._,. - _ ,��, . �,.. .��. <br />