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,£ ���i^w�v��'�•'''9 yr^""" �*.�,'a+ro . � .� ..�,.' kT ' <br /> a. s y }.,a , . � a'� <br /> . � <br /> WOOD BURNING EOUIPMEN'T <br /> Wood stove with flue <br /> Wood combination or add-on <br /> �z �� �( Factory fireplace with flue <br /> Factory Fireplace (s) Freestanding Masonry <br /> Wood Stove (s) Franklin, other <br /> Brand Name � ����� �-��-���f �r min i �F�IC;�P�ra Model No. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> �_�c>,�����1��.tr��-- j-`=,�-i�, <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfin <br /> No. Other Fans: Locations cfm <br /> FUEL STORAGE (N1UST BE APPROVED BY FIRE MAP.SHAL) <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 ($35.00) <br /> � y- < x .ol2s $�3 . �C� <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ <br /> or $.50, whichever is greater (contract price) <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 J�: <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, � <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 />�`,` <br /> � ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is <br />�;, <br /> greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price. � <br />� � <br />:.�� The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do <br /> 4" 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 />�� C� ; <br /> > - <br /> , � � � �_ Date: ' <br />�,. Applicant s Signature:, � �� - <br />�:'�� � <br />�r Approved By: Date: <br />��;' <br />�;: <br /> �r f _�, e � Y; - � �. F ,;r <br /> �s n� F j 1'�� + 3 } � <br />��,s <br /> ' :� � �, � � � ,' `' �� ' ..�` <br /> �..._�..�_ �a� a, _.��.��� �,.�. ; '?��.. _,�... � .. .:��3�.�;� m�:. .. .. ..,._.y, �� ._ .�. . .�.�...� � . _ b J .. <br />