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!� � <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 /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> VENTILATION =- <br /> No. 1 Kitchen Exhaust �ducted recirculating�p�cfm <br /> No. � Bath Exhaust (must be ducted outside) �_ cfm <br /> No. �_ Other Fans: Locations 1 1 cfm <br /> FUEL STOlaAGE �P✓IUST BE APPROVEB 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 Fee ($35.00) � <br /> '7�.00 .ao X .oi2s $ � <br /> (contract price) <br /> 2. State Surchar� ** Add the State Building Code Division <br /> Surcharge to each perniit. ��_(x� x .0005 $ <br />;� or $.50, whichever is greater (contract price) <br /> ��;�: <br /> e;�. <br /> s;a, <br /> ` 3. Posta�e and Handling (Only mail-in applications) $ 1.50 <br /> ''� 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ G� � • 1� <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 fumished by the owner, <br /> tenant or any other party the reasonable market vzlue of such items must �e ad�ed :o 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 .0005 of the contract price under $1,000,000 or $.50 - whichever is �;f <br /> greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price. ;�f <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 f <br /> � <br /> State Building Code, and certifies that all statements made on this application are complete, true yf <br /> and conect. j. <br /> � <br /> Applicant's Signature: �� Date: � al � l E <br /> Approved By: Date: <br /> . ; <br /> , , ; <br /> , - . ' � , <br />