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.� � <br /> WOOD BURNING EQUIPMENT <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 /> 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 APPROVED BY FIRE MARSHAL) <br /> z �.;•x��: Installation Removal <br /> k,' �;. <br />��;���,���� Fuel oil: gallons underground inside outside <br />� ` LP Gas: gallons <br />.�,. <br /> Other Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee 35.00 <br />�_:��� /S�' x .0125 $ =J���� <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ ;�� �� <br />;�_F or $.50, whichever is greater (contract price) <br />�, 3. Postage and Handlin� (Only mail-in applications) $ 1.50 <br /> _�! 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �s� `1� <br />��: <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 />�; <br />-- customer for the work done. If any material, equipment, labor, or installation are furnished by the owner, <br />:�:a tenant or any other party the reasonable market value of such items must be added to the estimated cost <br />�;:c <br /> or contract price for pernut 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 />�: <br /> ,;; <br />'�;L ** 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 /> j�, 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 /> �,. <br /> �� State Building Code, and certifies that all statements made on this application are complete, true <br />:�;� <br /> and correct. <br /> �;. ^ .� > <br /> x Applicant's Signature: (�' Date: l�� 15�`� <br /> ,�.` <br />� ;; Approved By: Date: �� � <br />��.,, <br /> ;�.�; <br />,c;,.� <br /> k i� , . �,� .. <br /> ...�� - . . . � . . � . <br /> �.i � .��` ... : ..... . ' . .. � � . . .. �.. ,. . <br /> f= -�. - '�. . .. : �� . . . . . . .. .. <br /> � .. . . .. � . .. . � . � . �. � . . � . . � � ' . . . � .� <br />