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. 1 <br /> . . <br /> �.� J <br /> ��BURNIlVTG E�pUIPMENT <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 /> Brand Name Model No. <br /> Mfgr's Min., Clearances, side , rear , min, flue dia. <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <br /> FLTEL STORA�E <NIUST �3E 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) <br /> iCJ����`Y' x .0125 $ �.����� <br /> (contract price) <br /> 2. State Surcharge. "* Add the State Building Code Division <br /> Surchar e to each ermit. - > > �`' � �L� <br /> g P �'�-C+�: , x .0005 $ <br /> or $.50, whichever is greater (contract price) _ <br /> 3. Posta�e and Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �; ;� �� �> <br /> * CONTRACT PRICE or JOB COST means the actual or estunated 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 work done. If any material, equipment, labor, or installation aze fumished by the 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 City 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 Depart;r,ent 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 /> A licant's Si nature: I� I �,`�Z��"' L� <br /> PP g �G� Date: <br /> Approved By: Date: <br />