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„� � <br /> WOOD BURNING EQUIPMENT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue <br /> � Factory Fireplace (s) Freestandin� Masonry <br /> Wood Stove (s) � Franklin, other � � � <br /> Brand Name Model No. <br /> Mfgr's Min., Clearances, side , reaz , 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 L.L- ��=�c1.. �� 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 /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> '� X .oi2s $ G�S .�� <br /> �`�GL ::� <br /> (contract price) <br /> � 2. State Surchar�e. ** Add the State Buildin� Code Division <br /> Surcharge to each permit. �>>C%� � x .0005 $ � _ �� <br /> or $.50, whichever is greater (contract price) <br /> , <br /> 3. Postage and Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �]�.t��, <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pernutted <br /> work including materials, labor, profit, and other fued 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 mazket 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 coFy of the actu� contract. <br /> ** The STATE SURCHARGE is .OQOS of the contract price under $1,000,000 or $.50 - whichever is <br /> greater. 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 regulations of the Minnesota <br /> State Building Code, and certifies that all statements made on this application are complete, true <br /> and correct. � — - _ <br /> ---- <br /> - � �� ; <br /> �_-_ � ,__ ,=�� � , <br /> � �, � � <br /> Applicant's Signature: � �--- � Date: -= - - <br /> _ _�--__ . <br /> Approved By: Date: <br />