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��P -fi�� � . <br /> a -� ��� <br /> --� � � <br /> � � � �� <br /> �D BURNING EQUIPMENT �,,I ,,J �tlr'� <br /> Wood stove with flue �t�' <br /> (�` Wood combination or add-on <br /> � Factory fireplace with flue <br /> � Factory Fireplace (s) Freestanding Masonry <br /> 0-' — <br /> Wood Stove (s) Franklin, other <br /> Brand Name /�(oT���- �,d,¢„i�, � Model No. 2 c�/ <br /> Mfgr's Min., Clearances, sici�, , rear , min. flue dia. <br /> Total <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath E�chaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <br /> Total <br /> I'UEL 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 /> P + IT FEE CALCUL�'TION <br /> 1.25% of Contract Price* or Nlinimum Fee ($35.00) 2 <br /> � ���_�� x 1.25 $ :��U� <br /> \� <br /> � (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> �l Surcharge to each permit. x .0005 $ /, / �� <br /> p (contract price) <br /> � ,, 3. Posta�e and Handling (Only mail-in applications) $ I?�D <br /> �' 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ <br /> 3 <br /> � * CONTTZACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> � work including materiats, 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 itetns must be added to the estimated cost <br /> O' 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 tlie submission of a signed copy of the actual contract. <br /> � � <br /> �`{ � �o ** The STATE SURCHF,RGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is <br /> .�3� greater. For valuations over $1,OU0,000 call the Department of Inspectional Services for the price. <br /> �' The undersigned hereby a�plies to the City for issuance of a Mechanical Permit, agrees to do <br /> all work in strict aecordance with the ordinances of the City and the regulations of tlie Minnesota <br /> State Building Code, and c.�rtifies that all statements made on this application are complete, true <br /> and conect. <br /> Applicant's Signature: ���%�`� t�� Date: %�/���� <br /> Approved By: Date: <br />