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♦i' <br /> ,' <br /> WOOD BURNING EQUIP�NT <br /> Wood stove with flue � <br /> Wood combination or add-on <br /> Factory fireplace with flue .` <br /> Factory Fireplace (s) Freestandin� Masonry <br /> Wood Stove (s) Franklin, other <br /> Brand Name Model No. <br /> Mfb's Min., Clearances, side , rear , min. flue dia. <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 STORAGE (MUST BE APPROVEB BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons under�round i.nside outside � <br /> LP Gas: gallons <br /> Other Gas opening <br /> � <br /> g �iP <br /> PERMIT FEE CALCULATION � <br /> l. 1.25% of Contract Price* or Minimum Fee ($3�.00) � <br /> � ��7���s� X .o12s � �.�S,aa �M <br /> (con[ract price) � <br /> 2. State Surcharge. ** Add the State Building Code Division '" <br /> Surcharge to each permit. x .0005 $ !,C�j <br /> or $.50, whichever is greater (contract price) <br /> 3. PostaQe and Handlina (Only mail-in applications) $ 1.50 , <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ,.�).,55 <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> work includin� materials, labor, profi[, 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 fumished 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 .000� of the contract price under �1,000,000 or 5.50 - whichever is <br /> Qreater. For valuations over $1,000,000 call the Departmen[ 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 reb lations 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 Si?nature:�=l y '_ Date:s�17-`�7 <br /> � ������. <br /> Approved By: Date: <br />