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J <br /> � �F' <br /> t� <br /> E:. <br /> Y <br /> `VOOD BT�R:�'G EQUI����E�]'I' <br /> Nood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue Maso <br /> Factory Fireplace (s) Freestanding �Y <br /> �ood Stove (s) Franklin, other <br /> Model No. <br /> Brand Name �n. flue dia. <br /> i�Tf�r's �iin., Clearances, side , rear , -. <br /> .. ;'' <br /> VENTIL�TION ducted recirculating cfm � <br /> No. Kitchen Exhaust �� <br /> No, Bath Exhaust (must be ducted outside) cfm Y`" <br /> No. O�her Fans: Location� �...___ _ <br /> F"UEL STOR�GE (�IUST BE APPROVED BY FIRE MARSHAL) � <br /> Installation Removal ; <br /> Fuel oil: �allons underground inside outside <br /> �allons <br /> � <br /> LP Gas: � Gas opening `� <br /> Other <br /> �;� <br /> PERMIT FEE CALCTJLATION ,; <br /> 1, 1.25�o of Contract Price�` or Mini����.00)x .0125 $ S�� — �'� <br /> (contract price) <br /> 2. State Surcharae. ** Add the State Buildin� Code Division ��� <br /> Surcharge to each permit. � "-�(Y�.! _ x .0005 $ f <br /> or 5.50, whichever is �reater (contract price) <br /> Q mail-in a lications) $ 1.50 <br /> 3, Postaae and Handlin_ (Only PP � <br /> 4 '1'pT�,L, PER�'�IIT FEE (Add lines 1-3 above) b <br /> � CO`jTRACT PRICE or JOB COST means the actual or estimated dollar amount chazged for the permitted ' <br /> work including materials, labor, profit, and other fixed costs. It is the amount ta be charged to the �- <br /> customer for tne work done. if any uiatzrial, equ:pmeat, :abcr, or installa!ion are f�srnished by he owner, <br /> reasonable market value of such items must be added to the�es�ated cost <br /> tenant or any other party the =�� <br /> or contract price for permit fee purposes. In the evenc that there is a dispute on the amount of the job cost, ,; <br /> the Ciry may request [he submission of a signed copy o2 the aemal contract. <br /> ** Tr,e STATE SURCHARGE is .000� oi the contract price under 51,000,000 or S.50 - whichever is <br /> �reacer. For valuations over 51,000,000 cail the Department of Inspectional Services for the price. <br /> The undersianed hereby applies to the City for issuance of a Mechanical Permit, agrees to do f: <br /> all work in strict accordance wi t h t he ordinance s o f t h e a ie on this a T e 1 ca t i n ef°mP e�es�e ' <br /> State Buildin� Code, and certifies that all statements m PP <br /> and correct. ,..�-] � <br /> ..--/ G!/ � <br /> / ���7 Date: r� � " <br /> Applicant's S ign.atur�:- ' <br /> • Date: <br /> Approved By: <br />��. . , ` � <br /> .,��.�.�,:.��r�.���..���._..0 _���....,_..���.�...�s��;,....:�_ . _..._ ,�_...vu,�,._..._...._�.m....�:�.w�... ..____ <br />