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'� R <br /> . .,..._ - - . . __ :. _ . . . _. . -`_ <br /> WOOD BURNING EQUIPMENT .. <br /> � Wovd stove with flue . ' <br /> � - Wood combi.nation or add-on ._ . <br /> � Factory fireplace with flue � � � <br /> � - Factory Fireplace (s) Freestanding : _ Masonry • <br /> � �wooa sto�e (s) Frankli.n, other ' <br /> Brand Name Model No. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. � <br /> Total <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculati.ng �� <br /> No. Bath Exhaust (must be ducted outside) �� � <br /> No. Other Fans: Locations �� � <br /> . Total <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground i.nside outside � <br /> L,p Gas: gallons <br /> Other Gas opening <br /> . PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> ;j,��� x .0125 $ <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code DiXisio�5 $ <br /> Surcharge to each permit. <br /> (con[ract price) <br /> � or $.50, whichever is greater 1.50 <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ <br /> 4. TOTAL PERNIIT FEE (Add lines 1-3 above) � <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 fized cosu. It is the amounc 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 thac 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 �°nrract- <br /> ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.SO - whichever is <br /> greater. For valuacions over $1,000,00� call the DePart�ent 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 t11e regulations of the Minnesota <br /> State Buildi.ng Code, and certifies that all statements made on this application are complete, true <br /> � and correct.---------_ . <br /> _ ,. _ .:._ _::� ., - � �L��� Date: �-�� — y�/ <br /> _ A licant's Signature: �-�°��z'v <br /> PP <br /> - . = . - Date: <br /> ' _. �. APProved By:.:�.. _- <br />