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WUOD�BURNING E�MEN'T . . _ — .- <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 /> Ta#al <br /> VENTILATION <br /> No. �_ Kitchen E:�haust � ducted recirculati.ng �_ �� <br /> No. �_ Bath Exhaust (must be ducted outside) �_ �� <br /> No. Other Fans: Locations �� � <br /> . 10� <br /> FLJEL STORAGE (MUST BE APPROVED BY FIRE M.ARSHAI-) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> p�,RI���'I' FF,E CALCLTLATION <br /> l. 1.25% of Contract Price* or Miriii�m�ce�e (�35_��� 0125 $ <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. (____r(�(Y� .�Q_— x •�5 $ a <br /> (contract price) <br /> � or $.50, whichever is greater � 1.50 <br /> 3. Posta�e and Handlin� (Only mail-in applications) <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) � �7�M <br /> � Cpti'I'RA�'PR:CE o:10B COST me�ns the actual or estimated dollar amount charged for the permitted <br /> work including materials, labor, profi[, and other fixed costs. It is the amount to be charge�l io the <br /> � customer for the work done. If any material, equipment, labor,or installation are fiirnished 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 che event that there is a dispute on[he amount of the job cost, <br /> the City may request the submission of a signed copY of the actual contnLt- <br /> ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - wiuchever is <br /> greater. For valuacions over $1,000,00� call the DePart�ent of Inspectional Servicxs 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 accorda.nce with the o�inanem��die n this appl�.�ti are ompl�etrue <br /> State Buildi.ng Code, and certifi that <br /> � and correct.---------- : <br /> _ .. .. �....- <br /> ....:.�.... _ . _ ... ._.. ... ..:_. _ - <br /> _- - - Date: <br /> _ Applicant'sSignatur . <br /> � ._ Date: <br /> . ,.- '. �'FProved By:..�:;.;.: , <br />