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�, ' � � � � <br /> 3::. <br />�-';4 <br />� WOOD BURNING EQUIPMENT , � <br /> � <br /> Wood stove with fl <br /> Wood combinatio or add-on <br /> Factory firepla with flue <br /><� Factory Fir ace (s) Freestanding Masonry <br /> Wood St e (s) Franklin, other <br /> Brand Name Model No. <br /> Mfgr's Min., Clearances, sid� , rear , min. flue dia. <br /> Total <br />� VENTILATION .; <br />` � No. � Kitchen E�chaust ducted recirculating cfm � <br /> No. �_ Bath Exhaust (must be ducted outside) _<;� cfm <br /> No. — Other Fans: Locations �� <br /> � <br /> Total �r'? c�M-S <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> , <br />}�'` Installation Re val <br />��� Fuel oil: gallons underground inside outside ; <br /> <� <br /> } LP Gas: gallons <br /> Other Gas opening � <br /> ;d <br />�;: � <br /> PERMIT FEE CALCULATION .,� <br /> F`�� 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> , . <br /> x 1.25 $ <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ . �v <br /> (contract price) <br />, <br /> 3. Posta$e and Handlin� (Only mail-in applications) $ 1.50 <br /> � 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �=%- 5a <br /> �:; <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollaz 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 />::'r:. <br />:� <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 /> t.. <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 /> Applicant's Signature: Date: <br />�` Approved By: Date: a 3 <br /> E ,:. , <br />