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� <br /> _ _.. . �— <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 Masonry � <br /> Wood Stove (s) Franklin, other <br /> Brand Name Model No. <br /> Mfgr's Mi.n., Clearances, side , rear , min. flue dia. <br /> Total <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath E�aust (must be ducted outside) �� <br /> No. ^v�cr F�: L.,�a�ia� �� � <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 /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.001 _���, <br /> �S�C; ``'% x .0125 $ � �� - <br /> {contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division � <br /> Surcharge to each permit. �'>�C - x .0005 $ ���� <br /> (contract price) <br /> or $.50, whichever is greater <br /> 3. Posta�e and Handlin� (Only mail-in applications) � • �S <br /> 4. TOTAL PERNIIT FEE (Add lines 1-3 above) � ��%• <br /> � ,.t �e i...��.�.i fnr'IZ�Yr+rrnil7�� <br /> * CONTRACT PRICE or JOB COST means the actuai or esii.uaceu u�u�:������" <br /> work including materials, labor, profit, and other fized costs. I[ is the amount to be charged to the <br /> customer for the work done. If any ma�erial, equipment, labor,or installation are fiunished by the owner, <br /> tenant or any other parry che reasonable market value of such items must be added to the estimated cost <br /> or contract price for pezmit 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 contra�i- <br /> ** The STATE SURCHARGE is .Q005 of the contract price under $1,Q00,000 or 5.50 - wtuchever is <br /> greater. For valuations over $1,000>000 call the DeP�ent of Inspectional $ervices 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 Buildi.ng Code, and certifies that all statements made\n this application are complete, true <br /> and correct --- __ � � , � <br /> _ - -- :._:_.. ':: ;��� ; � �,'' j Date: `"/�5' �, <br /> _ Applicant's Signature: � <br /> = � � va�: 8�i�1�'� <br /> Approved By:._ . � ` ' <br /> p ���� . If�l.° GE t� <br />