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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. Kitchen Exhaust 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 /> 1. 1.25% of Contract Price* or Minimum Fee ($35.001 • <br /> i- i ��:� c -c:� x .oi2s � .�-I . �l �, 35.�o m�►� <br /> (contract price) " <br /> 2. State Surchar� ** Add the State Building Code Division r $� <br /> Surcharge to each permit. !-";,"'i �=��- x .0005 $ ; `]L`. <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handling (Only mail-in applicafions) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ,� -�. �SL / <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 chazged to the <br /> customer for the work�one. If any material, equipment, labor, or installation aze 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 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 .OQOS 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� ���'�'��' ��'�-�=��"E'L�l �, Date: �• � �� <br /> Approved By: Date: <br /> . . . . .. � � . :4'.-'.. •�x- � .. . '�" � .. � . <br /> � .. , . . ' . � � - . -. . . .. � - . �. . � .�� <br /> .iR <br />