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. . � , <br /> WOOD BURNING EOUIPMENT <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. 1 Kitchen Exhaust ducted recirculating cfm <br /> No. � Bath Exhaust (must b ducted outside) 7� cfm <br /> No. �_ Other Fans: Locations V�� �4.r yA's Fx���yar- � cfm <br /> vc,�-�i 1,�f e� <br /> L STORAGE (MUST B�APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> �_ Other /��t--r�f�.l (�S �� Gas opening <br /> �-r.,r,�,�CeS��-u,.+.r 4.e<<e��4- F,rep'1aae5jCopKTOP1�r�(P:i'� (�ool �c��\e� <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> ��, �5c`� :'�' x .0125 $ �7�'.� <br /> (contract price) <br /> 2. State Surchar� "" Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ � � .� <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ��'7 ,� <br /> * CONTRACT PRICE or JOB COST means the actual or estunated dollar 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 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 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 ce i es that all state ts made on this application are complete, true <br /> and correct. <br /> Applicant's Signature: Date: J �� R� <br /> Approved By: � � Date: � OZl <br /> v <br />