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�o _as-i�- <br /> � I� ��Q� C�.-�f� ���c.�v�,� � Q..���''�'�'�`c•2� �csi� <br /> ''�K�J2;�-`.'- / � � r <br /> � � � l� �� �� � / ` � <br /> C%� � � G Lr20 <br /> ,y�L 0 <br /> WOOD BURNING EQUIPMENT � <br /> Wood stove with flue ��� <br /> Wood combination or add-on <br /> _� Factory fireplace with flue �j�+s i �'�-`�' C��'�`�t � <br /> Factory Fireplace (s) Freestanding Masonry <br /> Wood Stove (s) Franklin, other <br /> Brand Name Model No. <br /> Mfgr's Min., Clearances, side�� , rear—G�— , min. flue dia. c:�' 7`' <br /> Total <br /> VENTILATION <br /> No. Kitchen Exhaust ductecl recirculating cfm <br /> No. Bath E�aust (must be ducted outside) cfm <br /> l�io. 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) �, rS � <br /> �;�'C�h . `'�' x .0125 $ <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division j -v <br /> Surcharge to each permit. � <br /> ���c�� ° V x .0005 $ . �. <br /> (contract price) <br /> or $.50, whichever is greater <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ `�D-s � <br /> * CONTRACT PRICE or 30B CUST means tne actual or est:mated doliar amount charged for the permitted <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 are furnished 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 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 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 cali 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 /> A licant's Si nature: ` ���'�';� Date: 7 �� <br /> PP � <br /> Approved By: Date: <br />