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WOOD BURNING EQUIPMENT_ <br /> Wood stove with flue .,�:�.��,,µ <br /> � <br /> Wood combination or add-on � ,,,� r��'`��` � �; <br /> Factory fireplace with flue <br /> Factory Fireplace (s) Freestanding Masonry <br /> Wood Stove (s) Franklin, other <br /> Brand Name Model No. <br /> MfQrr'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 under�round inside outside <br /> LP Gas: gallons <br /> Other Gas open.ing <br /> e <br /> PERMTT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Mini um Fee 3�.00 � <br /> - ,.�,�,�C� x .0125 $ ,�•�' <br /> (contract price) <br /> 2. State Surcharge. ** Add the State uilding Code Division <br /> Surcharge to each permit. ..� ���' x .0005 $ �,�a <br /> or $.50, whichever is greater (concracc price) <br /> 3. Posta,�e and Handlin� (Only mail-in applications) $ .1.5 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ � � <br /> �/.,���-/�G� <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the perm.itted <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 furn.ished by the owner, <br /> tenant or any other party the reasonable market value of such items must be added [o the estimated cost <br /> or contract price for permit fee purposes. In the event that[here 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 .000� of the contract price under 51,000,000 or 5.50 - whichever is <br /> $reater. 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 Buildin� Code, and certifies that all statements made on this application are complete, true <br /> and correct. <br /> /� � '" <br /> , ; q� , <br /> Applicant's Signature: � Date: � <br /> Approved By: <br /> ��'1' (� � � Date: �� �7i �� <br />