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WOOD BURNING EQUIPMENT � <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 /> VENTILATION <br /> No. Kitchen E�aust ducted recirculating cfm <br /> No. Bath Exhaust (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: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> PERNIIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minim m e 35.00 n <br /> x .0125 $ �O►��J <br /> (contract price) <br /> 2. State Surchar� ** Add the State Buildi/n.� Code Division <br /> Surcharge to each permit. ��U x .0005 $ ���� <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ � 6� <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 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 furnished 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 pernut 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 p�rfce under $1,0OO,OfJO or $.50 - whichever is <br /> greater. For valuations over $1,000,000 call the Dep ment of Inspectiqua�' S,ervices for the price. <br /> The undersigned hereby applies to the City for iss � of a M c�ianical ermit, agrees to do <br /> all work in strict accordance � t~.he o�ances,q� e City e regula�s o� the Minnesota <br /> V '� � i <br /> State Building Code, and ce�tifies tha�'all state t made o this applic on ar,e complete, true <br /> , , � � � <br /> and correct. �� <br /> i i` %� <br /> �� � � �� � � � � � (�� <br /> Applicant's Signature• � �D"ate:� / 4'.J- <br /> ��. .... ,___ _ <br /> Approved By: Date: <br />