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�-: <br /> � � � <br /> + _ � - <br /> WOOD BURNING EQUIPMENT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> � Factory fireplace with flu y <br /> Factory Fireplace (s) � Freestanding Masonry � <br /> W d tove (s) ,� Franklin, other q <br /> BrandN�nie ,�.���� L���--�.�-' ModelNo. � `� �;�'�...�- � <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. � <br /> Totai �;� • C� �� <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> �vo, Gtlier Far,s: Locaticr; �� <br /> . Total � <br /> ;;,:�, <br /> � <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHEiL) _ <br />�� Installation Removal ' <br /> �: Fuel oil: gallons underground inside outside <br />�� LP Gas: gallons '; <br /> .�., <br /> Other Gas opening <br /> :� <br /> ak�� PERMIT FEE CALCULATION � <br /> � 1. 1.25% of Contract Price* or Minimum Fee ( 3S.G4) � <br /> � �(�,. `�;� x .0125 $ �`,�7 •� <br /> �;� (contract price) <br />�;� 2. State Surcharge. ** Add the State Building Code Division <br />��; Surcharge to each permit. I ���� ��;!��- x .0005 $ . �� <br />�� (contract price) <br />� or $.50, whichever is greater <br />``� 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br />��.�; <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ � �a �� <br /> * CO�'TF�CT F2ICL�r��B COST mea�s the a��.:al �:esti�ated dall..r arseun2 c�arged for Lhe permittPd <br /> work inciuding 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 />,�§, <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 /> ** 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 d certifies that all statements made on this application are complete, true <br />��; and correct. ' <br />�_ � <br />�� Applicant's Signature: c � Date: � <br /> �. <br /> _ Approved By: Date: <br /> :�: <br />