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� .`1,:... , .. �. ` -.:_. .",,..� ._, . "'4;i': r .., . . . . .^'t "ry'9i'. <br /> t <br /> _ ... . . . . . , . � . .. . �. .. .. . . � . . .. . . . .. �{ . . .. <br /> WOOD BURNING EQUIPMENT ' <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 />`<`' FL�EL 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 /> ,. <br /> - PERMIT FEE CALCULATION <br /> s 1. 1.25% of Contract Price* or Minimum Fee ($35.00) o � <br /> Z.6 S�: �`' x .0125 $ 3� <br />� , (contract price) <br />� . 2. State Surchar� ** Add the State Building Code Division � <br />;� Surcharge to each permit. ��'bp `' " x .0005 $ � � � <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �3—T� S� <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 mazket value of such items must be added to the estimated cost <br /> or contract price for pernut 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 .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 cer�ifies that all stateme made on this application are complete, true <br /> and correct. `�� � <br /> � `,. <br /> Applicant's Signature: ' � � � �� � Date: J j �' Z`6—� Z <br /> Approved By: Date: <br /> . . � .. . , � <br />