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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 ?iE 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 Fee ($35.00) <br /> �,C7''7� �?�-� x .0125 $ �,�.`�-C�L � <br /> (contract price) '' <br /> 2. State Surcharge. ** Add the State Building Code Division =� <br /> Surcharge to each permit. �, c��; �_"z_ x .0005 $ /, UZ1 wi <br /> or $.50, whichever is greater (contract price) � <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT rEE (Add lines 1-3 above) $ <�37,-5�C <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount chazged for the permitted <br /> work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the �� <br /> custome;for the work done. If any material, equipmeat, labor, o:installation are fi:rnished by the own�r, <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 /> [hc City may request [he submission of a signed copy of the actual contract. <br /> ** The S'1'ATE 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 appl ic� to the City for issuance of a Mechanical Permit, agrees to do <br /> all work in strict accurc!ance with the ordinances of the City and the regulations o�the Minnesota <br /> State Building Code, and certifies that all statements made on this application are complete, true <br /> and correct. <br /> � l� <br /> Applicant'sSignature: G�' '�� ,�- ,l.�C ''�Z��..- Date: �J <br /> ,-�:� <br /> Approved By: � �;� �l�(�,/t,l�Q� Date: L` �� <br /> . � `, � <br /> �� <br /> ��,.: <br /> � <br /> ;� <br />