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� <br /> WOOD BURNING EQUIPn�ENT � <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue <br /> Factory Fireplace (s) Freestanding i 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 /> FIJEL STOFtAGE (MUST �3E APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other � Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum �ee ($35.00) <br /> ��j. (]U x .0125 $ �j.� <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. �(z"�,��_ x .0005 $ e`j� <br /> or $.50, which�ver is greater (contract price) <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT PEE (Add lines 1-3 above) $ 3�`l.CX� <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 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 S'fAiE SuACFiARvE is .�OvS ai ii�e contract price ur�ucr $1,CQC,CCO or $.SC - wh:chever is <br /> greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price. <br /> The undersigned hereby appl i,:s to the City for issuance of a Mechanical Bermit, agrees to do <br /> all work in strict accurc!ance with the ordinances of the City and the regulations oL 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:OCe��PCt ,�J \�72.P/1� Date: ��^ <br /> Approved By: Date: <br /> � , .: . � r <br /> ��,�� � `t �. ��� , � , � <br /> ` ''' � `' �'��,. _ � ;��'�. _ ' . � .�. . � � �_.. � , �� "� <br /> �:a':o9 .,..�.��iLo. ?�iXc...,,�c�1 "�`k 4` �,.�M' � '=5vvv�4a' . .�....�s <br />