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. <br /> � . F <br /> WOOD BURNING EQUIPMENT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> I=actory fireplace with flue <br /> _� Factory Fireplace (s) � Freestanding Masonry <br /> Wood Stove ,(s) Franklin, other <br /> Brand Name /?�'1��,e�.�c�C., Model No. /�!��'�y�/�— <br /> Mfgr's Min., Clea nces, side , rear , min. flue dia. � �� <br /> � <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <br /> FUEL STOF�AGE (MUST �E APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons �� <br /> Other Gas opening � <br /> ,� <br /> � <br /> PERMIT FEE CALCULATION �-�� <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) i� <br /> � <br /> l�<� � x .0125 $ �..�, �%�� <br /> (contract pricc) '' <br /> 2. State Surchar� ** Add the State Building Code Division <br /> Surcharge to each permit. i � , t�%L� x .0005 $ 3� .� <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) $ <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 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 tha[there is a dispute on the amount of the job cost, <br /> the Ciry may request the submission of a signed copy of the actual contract. <br /> ** The S'IATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is <br /> greater. For valuations over $1,000,000 c�ll the Department of Inspectionai Services for the price. <br /> The undersigned hereby a�pl i,;s to the City for issuance of a Mechanical Permit, agrees to do <br /> all work in strict accurc!ance with the ordinances of the City and the regulations of the Minnesota <br /> State Building Code, and certifies that all statements made on this application are complete, true <br /> and correct. <br />� ,. <br /> ` Applicant's Signature: Date: <br /> Approved By: Date: sF>/$,�/� <br />