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� <br /> i <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 /> � <br /> VENTILATION . � I <br /> . ; <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm ' <br /> No. Other Fans: Locations cfm <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) � <br /> Installation Removal ° <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons i; <br /> Other Gas opening : <br /> � <br /> PERMIT FEE CALCULATION � �° <br /> � 1. 1.25% of Contract Price* or Minimum Fee ($35.00) 1� <br /> ��il.��� x .0125 $ I�:' ,�� � <br /> ; <br /> (contract price) � <br /> 2. State Surchar�e. ** Add the State Building Code Division / , <br /> Surcharge to each permit. �L''� x .0005 $ � `�� <br /> or $.50, whichever is greater contract price) <br /> ` i <br /> 3. Posta�e and Handling (Only mail-in applications) $ 1 5 . <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ - " <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> work including materials, labor, profit, and other fized costs. It is the amount to be charged to the <br /> customer for the work done. If any material, equipment, labor, or installation are fumished by the owner, � <br /> tenaut or any other party the reasunable market ��alue of such :tems 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 certifies that all statemen s made on this application are complete, true <br /> and correct. <br /> ' C��� � ' ,�� <br /> Applicant's Signature: Date: <br /> � , <br /> Approved By: ;�'�, � �f�•� Date: �-6 5� <br />