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. <br /> `VOOD BLR.�'G EQTJIP���1'T <br /> `�ood stove wirh flue <br /> Wood combination or add-on <br /> Factory fireplace with flue <br /> Factory Fireplace (s) Freestanding Masonry <br /> �Vood Stove (s) Franklin, other <br /> Brand Name Model No. <br /> �ifQr's 1��iin., Clearances, side , rear , min. flue dia. <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> �o, Bath Exhaust (must be ducted outside) �� <br /> NO. QLhPr Fans: Locations _ cfm <br /> FUEL STOR�GE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: �allons underground inside outside <br /> LP Gas: gallons <br /> Other Gas openin� <br /> PERIVIIT FEE CALCULATION <br /> 1. 1.25 9a of Contract Price�` or vlinimum Fee ($35.00) \ <br /> �SOO� x .0125 $ ��-�� _ <br /> (contract price) <br /> ? State Surcharae. ** Add the State Buildin� Code Division <br /> Surcharge to each permit. �G� � x .000� $ e �d <br /> or 5.50, whichever is greater (contract pnce) <br /> _ 1.50 <br /> 3. Postaae and HandlinQ (Only mail-in applications) � <br /> 4, TOTAI. PERMIT FEE (Add lines 1-3 above) � � 7-�� �— <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> work includin� materials, labor, profit, and other fixed costs. It is the amount to be char�ed to the <br /> customer for the work done. If any material, equipmenc, labor, or inst��lation a.*e furrnished by the owner, <br /> tenant or any other parry the reasonable market value of such iteazs must be added to the estimated cost <br /> or contract price for permit fee purposes. In che event that there is a dispute on the amount of the job cost, <br /> che Ciry may request the submission of a signed copy of the acrual concract. <br /> ** The STATE SURCHARGE is .0005 oi the contract price under 51,000,000 or 5.50 - whichever is <br /> �reater. For valuations over S1,000,000 call the Departmen[ oi Inspectional Services for [he price. <br /> The undersianed hereby applies to the City for issuance of a :�Techan.ical Permit, agrees to do <br /> all work in strict accordance with the ordinances of the City and the regulations of the Minnesota <br /> State Buildi.n� Code, and certifies that all statements made on this application are complete, tnie <br /> and correct. <br /> � ��� � �- � y� <br /> A licant's Signature: �/t C,�' � Date: <br /> rr <br /> Approved By: Date: <br />