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. <br /> � , <br /> WOOD BL�R:�`TiV'G EQUIP'•VIENT <br /> � Woc�d 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 � U �-��_i�t c� f^ Model No. NC L 5'L}.�G�� <br /> Mfgr's Min., Clearances, side�_, rear�_, min. flue dia. / <br /> Total / '' <br /> VE�ITILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> l�To, Other Fans: Locatioas 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 /> PERIVIIT FEE CALCULATION <br /> 1. 1.25% of Contract Price'� or Minimum Fee 35.00 �J a�; <br /> �/C>C�G� x .0125 $ <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ % �C� <br /> (contract price) <br /> or $.50, whichever is greater <br /> 3. Posta�ye and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ � �, �C <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pernitted <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 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 statements made on this application are complete, true <br /> and correct. <br /> Applicant's Signature: �%�`�'��i����� �% Date: �a�� <br /> �, <br /> Approved By: Date: <br />