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. ' r , � <br /> `'�'O011 BURNING EQUIPMLNT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> �_ Tacto�y fireplace with flue <br /> Factory Fireplace (s) Freestanding Masonry <br /> Wood Stove (s) Franklin, cthe: <br /> Brand Name ��,(��� ��� ' _ Model No. �S� -y-e `�� <br /> Mfgr's Min., Clearances, side _�, rear�, min. flue dia. /�;" <br /> V�NTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cftn <br /> No. Other Fans: Locations cfm <br /> FUEL STORAGE (MU5T 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 /> l. 1.25% of Contract Price* or Minimuin Fee ($35.00) <br /> ��? .�����x .0125 $ ,��, r� �, <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to eacll permit. �,(')(����� x .0005 $ � � (�U <br /> or $.50, wllicl�ever is greater (contract price) <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FI:E (Add lines 1-3 above) $ '�3 7, � � <br /> * CONTRnC'I' PRICG or JOB COST mcans thc actual or estimatcd dollar amount chargcd for Ihc��crmittcd <br /> work including materials, labor, profit, and other fixed costs. It is the amount to be charged to thc <br /> customer for the work done. If any matcrial, equipment, labor, or installation are furnished by the owner, <br /> tenant or any other party thc 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 /> ** Thc STnTE SURCIIARGE is .0005 of thc contract Price undcr $1,000,000 or $.50 - whichevcr is <br /> grcatcr. For valuations ovcr $1,000,000 call thc Dcpartmcnt of Inspcctional Scrviccs for thc pricc. <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do <br /> all wor-k 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 /> Applicant's Signature: � � Date: <br /> Approved By: Date: <br />