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r. � � <br /> WOOD BURNING EQUIPMENT . . � -- - <br /> Wovd 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 /> BrandNa�ie�'� �,.,Ct�'1.�� ��'���-� ModelNo. 1`�j 1 Q - <br /> Mfgr's Mi.n., Clearances, side , rear , min. flue dia. � <br /> Total . ��_____ <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> tv�. Other Fans: Locations __ _ �� � <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 CAI.CULATION <br /> 1. 1.25% of Conuact Price�` or 1�Iinimum F'ee ��35.04 <br /> ���� , x .0125= $ �� . �� <br /> (contract price) Z� ' � <br /> 2. State Surchar�e. ** Add the State Building Code�Division � t � <br /> Surcharge to each permit. 2,� � �;C; � �-' X •�5 $ <br /> (contract price) <br /> or $.50, whichever is greater <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �� • l �'C� <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the perm.itted <br /> work includi.ng matenals, iabor, proiit, and otae: fi:�c.i c�ss• Tt i: .�e a.�:�<:�� Ic be chargeci ro rhe <br /> � customer for[he work done. If any material, equipment, labor,or installation are fiunished b}/the owner, <br /> tenant or any other parry the reasonable market value of such items must be added to the estimated cost <br /> or contract price for perm.it fee purposes. In the event that there is a dispute on the amount of the job cost, <br /> the City may reques: 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 $1,000,00� call the De'Partment of Inspectional Services for the price. <br /> The undersigned hereby applies to the City for issuance of a Meci�anical Perm.it, agrees to do <br /> all work in strict acc ce with the ordinances of the City and the regulations of the Minnesota <br /> State Building Cod , and ertifies that all statements made on this application are complete, true <br /> and correct. ----_- -- , , . � { <br /> .._ _ -- ._-; . . � Date: �� 2%� �''t <br /> _ Applicant's Signature: <br /> = Date: <br /> Approved By:-_.':. _ - , <br />