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*';; <br /> y � <br /> �� <br /> . "�; <br /> �� <br />. , <br /> +- <br />" WOOD BURNING EOUIPMENT <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 />� �: <br />'` Mfgr's Min., Clearances, side , rear , min. flue dia. 4 ' <br /> a �- <br /> �� ,a <br /> ... <br />�; VENTILATION <br />;' No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br />� IV'o. Other Fans: Locations cfm <br /> a �..,, <br />�` FLTEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br />��� Installation Removal� � � <br /> A , <br />.��: Fuel oil: gallons underground inside outside <br />��'. LP Gas: gallons <br />�� ' Other Gas opening <br /> k.;; <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) , I �/ <br /> �j'� -J�'� , � x .0125 $ �-t L�b � <br /> (contract price) � <br /> << <br /> 2. State Surchar.�e. "" Add the State Building,�Code Division �� � <br /> Surcharge to each permit. �j���C%��� x .0005 $ � �� SL� <br /> or $.50, whichever is greater (cbntract price) �'4 <br /> ; <br /> 3. Posta�e and Handling (Only mail-in applications) $ 1.50 <br /> Q. TOTAL PERl��IT FEE (Add lines 1-3 above) $ .� , , <br /> , <br /> * CONTRACT PRICE or JOB COST means the actual or estunated dollar amount charged f�t�e pe�'rnutted <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, equipr.ient, labor, or installation ue furnished by zhs 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 pemvt 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. s���. <br /> ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is `�-x <br /> greater. For valuations over $1,000,000 call the Department 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 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 /> � � � <br /> Applicant's Signature: %� ;% �l C� -��%'�C/� �' Date: _ " -� <br /> Approved By: Date: I �Z4-� <br /> � �_ <br /> �'S : <br /> �,�. ^; <br />