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i r <br /> l � <br /> WOOD BURNING EOUIPMENT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue <br /> �_ Factory Fireplace (s) Freestanding Masonry <br /> Wood Stov (s) Franklin, other <br /> Brand Name �-a.._p.-� � �� Model No. — �' <br /> Ivirgr's Min., Clearances, side , rear , min. flue dia. <br /> VENTILATION <br /> No. � Kitchen Exhaust X ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> '1V0. CtI1ZT I'�IIS: Lacatior.s r�n <br /> FUEL STO�GE MUST BE APPRO BY FIRE MARSHAL)� �� <br /> ( <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�$35.00) �.� � �� <br /> S � DO x .0125 $ <br /> (contract price) <br /> � 2. State Surcharge. ** Add the State�Bu 1�mg Code Division a ; �� <br /> Surcharge to each permit. � `�'t�� `'� x .0005 $ <br /> or $.50, whichever is greater (contract price) <br /> � : <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �� ,� (7 <br /> * CONTRACT PRICE or JOB COST means the actual or estirnated 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 wurk done. ii auy n�teri�:, ei;aipment, lauo:, or utis:al:ation::e fi�rr.ished hy thP 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 pemut fee purposes. In the event that there is a dispute on the amount of the job cost, <br /> the Ciry 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 $.50 - whichever is <br /> greater. For valuations over $1,000,000 call the Department of Inspectional 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 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 Signatu . ���_} Date: <br /> Approved By: Date: <br />