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WOOD BURNING EQUIPMENT � <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fueplace 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 /> Total <br /> VENTILATION <br /> r1o, Kitchen Exhaust ductecl recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. � Other Fans: Locations ��-� �� Sr�/D /,�� �_ c� �a��1 � <br /> Total � <br /> ���/���S � S� � <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 F'EE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) �_ �,�;_ <br /> �y��;���; x .0125 $ ��.� <br /> (contract pr:ce) <br /> 2. State Surcharge. ** Add the State Building Code Division � <br /> Surcharge to each permit. I `-4 ,=� t>C. x .ODOS ,� $ �- �� ° <br /> (c'ontract�price) ,� � <br /> '� <br /> or $.50, whichever is greater , :� <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 `�� <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ � r,. �< ���-� �� <br /> �, <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pernutted ;.� <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, a <br /> �g i <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 /> r� <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 /> �<� <br /> Applicant's Signature: �'Y�-� � Date' �� `�1 � � <br />�a�' n �, Date: � � <br /> Approved By: <br /> ,:,:, <br />�x <br />���:: ` <br /> s .. <br /> �; <br /> r�.�..���..m_.e.�,a......�. _ a � � _ .. ....._ .��___. .. .. <br />