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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) Freestanding Masanry . <br /> Wood Stove (s) Franklin, other <br /> Brand Name Modei No. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. � <br /> Total <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating �� <br /> No. Bath Exhaust (must be ducted outsidej �� <br /> No, Other Fans: Locations �� � <br /> . Total <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAI-) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas openi.ng <br /> PER�'�IIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($�?0�1 -� <br /> %��1 � . _ x .0125 $ ��-J� <br /> (contract price) <br /> 2. State SurcharQe. ** Add the State Building Code Division <br /> -� �� <br /> Surcharge to each permit. I�I�(J , — x .0005 $ �• — <br /> (contract price) <br /> or $.50, whichever is greater 1.50 <br /> 3. PostaQe and Handlin� (Only mail-in applications) � <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) � �� � �� <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> work inciuding materials, labor, profit, and other fized cosu. It is the amount to be charged to the <br /> customer for the work done. If any ma�enal. e4u�Pment, labor, or installation are furnished by the owner, <br /> tenant or any other parry the reasonable market value of such items must be added to the estimated cost <br /> or contract 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 submission of a signed copy of the actual contract. <br /> ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or 5.50 - whichever is <br /> greaier. For valuations over $1,000,000 ca11 the DePartment of Inspec.'tional 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 tb.e CitY and the regula�o�O�ie�eSOtrue <br /> State Buildi.ng Code, and certifies that all statements made on this agp P <br /> and correct -- -- _ ' <br /> . _ .:.�.� .: r� „ — � �'– Date: �� �����J� <br /> _ Applicant's Signature: � <br /> = . �,^��.� '� Date: � �� �', <br /> Approved By:_ �.. <br />