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. <br /> � � <br /> r <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 E�aust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <br /> _ FUEL STORAGE (MUST BE 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 /> �-, <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> �/�'o�, ,.�� x .0125 $ <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division � <br /> Surcharge to each permit. x .0005 $ <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br />� .:,-, . <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount chazged for the pemutted <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 />�;,_;.,� ., <br /> � ** 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 /> and correct. <br /> Applicant's Signature: � � ���� Date: ��l"s1 1� " <br /> ;;,,:. . <br /> Approved By: Date: <br /> ,_. <br />� _ _ <br />�� , . � , : <br /> , <br /> , <br />� . • <br />�., <br /> � , <br />