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�.: <br />�:;,- - <br /> .,, ; <br />�,"'` <br /> WOOD BURNING EQUIPMENT � <br /> i� Wood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue <br /> � � �Factory Fireplace (s) Freestanding Masonry <br /> p4 <br /> Wood Stove (s) Franklin, other <br /> Brand Name Model No. <br /> Mfgr's Min., Clearances, side� , rear , min. flue dia. ; <br /> Total <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm `` <br /> No. Bath E�aust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm � <br /> Total <br />�' '� <br />�� FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br />;:a` <br />� Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br />�:' <br /> Other Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> x 1.25 $ <br /> (contract price) <br />_��: 2. State Surcharge. ** Add the State Building Code Division <br />`�✓ Surcharge to each permit. �< <i���=; � <br />