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�,,� T <br />` - , . <br />�;,: , <br /> ;,:� <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 />#;�` <br /> �� FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br />��' Fuel oil: gallons underground inside outside <br />}. <br /> LP Gas: gallons <br /> G <br /> Other Gas opening <br />�}�' <br /> PERMIT FEE CALCULATION <br /> y '� 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> �,f;�'�<;;�C. x .0125 $ <br />�.�; �(contract price) � <br />�;� 2. State Surchar�e. �`* Add the State Building Code Division <br />�" Surcharge to each permit. �a rj�:��C�' x .0005 $ <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 />�i''; <br /> `r <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 pernut fee purposes. In the event that there is a dispute on the amount of the job cost, <br /> the City, �ay request the submission of a signed copy of the actual contract. <br /> ;;.a;• ** 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 />'`�'' 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 />��i and correct. <br />�� ' - , <br /> Applicant's Signature: Date: � - f Z- �'� <br /> Approved By: _ Date: ��� <br /> � . , <br />