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� <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 /> Total �` <br /> ,�� <br /> � <br /> VENTILATION s'� <br /> No. Kitchen Exhaust ductecl recirculating cfm <br /> iv�. Bat�'� E�haust (r.7�st �e �»cte� eutsid�) cfm <br /> No. Other Fans: Locations �� <br /> Total <br /> �� <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) �� <br /> Installation Removal �� <br /> Fuel oil: gallons underground inside outside �F=� <br /> LP Gas: gallons <br /> Other Gas opening <br /> I'�e.R1t�gIT +,s,; �A;.CL��:�'!'1��N <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> j;l�U x .0125 $ �S. J� � <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division ' �S <br /> Surcharge to each permit. /7/�J x .0005 $ <br /> (contract price) <br /> or $.50, whichever is greater <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 ,k� <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ � � 3`�� � <br /> �, <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted �� <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 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. 7'' <br /> The undersigned hereby applies to the Ciry 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 /> ' Date: , / j� <br /> Applicant's Signature: � �� <br /> � <br /> Approved By: Date: <br /> � <br />