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11-23-1998 9:���! FROr-1 FIRE�IDE CORNER 612 6�3 8884 P. � <br /> � ti - <br /> W�C QD Bt7��VG EOU�PMEN� <br /> � Wood sto�e with fluc ' <br /> Wood combination or add-on <br /> Factory fireplace with flue <br /> Factory Fireplace (s) Freestanding Masozu'y <br /> Wood Stove (s) Franklin, other <br /> Braad I��ame 3��ode1 No. <br /> Mfgr's Min., Clearances, side , reax , min. ffue dia. <br /> Total <br /> �rE.N'X'I.�,ATION <br /> No. Kitchen Exhaus� ducted recircutating cfua <br /> No. Bath Exhaust {must be ducted outside) cfm <br /> No. Ocher Fazu: Locations � cfm <br /> Tatai <br /> FLTEL Sx'O GE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons under�round xnside outside <br /> LP Gas: callOns <br /> Other Gas opez�izlg <br /> PERMIT F�� CALCULATI(JN <br /> 1, 1.2�% of �ontract Price* or Minimum �ee (�35.00) <br /> ..33a�� X .o��s � �i.as _ <br /> (contract pric.�) <br /> 2. State Surcharse. ** Add the State Buildin� Code Division <br /> Surcharge to eaclt permit. x .0005 � <br /> (Goatract price) <br /> or �.50, whichever is greaiez <br /> 3. PoscaQe az�d Handlin� (4n1�� xnail-ia appticarioris) � 1.50 <br /> 4. TOT1�1L PERMIT FE.E (Add lines 1-3 above) $ <br /> � CONTRACT PRJCE or IOB COST meaus the actual or esumacai dollar azuount charged for the permiRed <br /> work inc�ud'vng materials, labor, profit, and or.bcr fviced costs. Ic is t2�e aznount to be chazged to the <br /> customer for the worl:dona. If auy materiai, equigm�nt, Iabor.or installation are fuinished by tt�c ownei, <br /> cemanc or any ot3�er parry the reasonabl� marber va�ue of such items must be added co the estimated cost <br /> or contrac.�pric�foz permis fee purposes. In rhe event tbat there is a disputc on the am.ounc of the job cost, <br /> ths Ciry may reqvcst che submission of a sigaed copy of ch� acma] conuacc. <br /> "^` 'I�e STA'I'E SURCFiARGE is .4005 af thc conuact pnce under 51,000,000 or �.SO - whichever is <br /> greacer. For Yatvations over 51,000,000 call thc Depanment of Inspeccional Services for thE p:icc. <br /> '�e undersi�ned hereby applies to the City for issuance of a Mechanical Permit, aarees ro do <br /> a�l work in sirict accazdanc� wich the ordinances of the Ciry and the zeaulatior�� of the Minnesota <br /> State Buildirig Code, and certifies that all statements made an thzs application are complete, true <br /> and correct. <br /> Applicazzt'sSzgnat�re: �d, ; � Date: ti <br /> Ap�roved By: Date: <br />