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. y <br /> �J�� � <br /> W D BURNING E UIPMENT <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 /> � .�...-� .�w. Model No. L-=�;(�.��.��.� —�'�..� <br /> BrandName��„. ,r5�i� - <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> Total <br /> VENTILATION <br /> No. Kitchen E�aust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations _ cfm <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 ($35.00) � ._�, r.,� <br /> �c cc �-" x .0125 $ . 5�.5 =""._.. <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division -�� % C'L� <br /> Surcharge to each permit. x .0005 $ >�� <br /> (contract price) ; <br /> or $.50, whichever is greater �. ��� <br /> 3. Posta�e and Handlina (Only mail-in applications) $ _ l-�� <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �' 7� . �-�' <br /> * CONTRACT PRICE or JOB COST means the actual or estima[ed dollar amount charged for the pemutted <br /> work including materials, labor, profit, and other fixed costs. I[ is tne amount to be i;harged to the <br /> customer for the work done. If any material, equipment, labor, or installation are furnished by che 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 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 artual 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,�00 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 /> � +/ �� �� � Date: �',' �' 6 `f�" <br /> Applicant s Signature: � �. �.;���.: ..--^�-'-�r� <br /> Approved By: <br /> '� Date: � <br />