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�;s , � _ .e-s�w s- n: - . . ; <br /> � <br /> � � t . rb� _ �_ �� , <br /> _ � ��t ,` > � j - Fw�. <br /> . . ' :x� r 4 � i �. .�. � e"j� <br /> . . . . �L� '/� ,�r <br /> ` i;� <br /> � 4 <br /> ..�. . .�._..;" �: .: . ...,..�..' .`�� �...... .-.. ,_.... ..'.�. _ '�. �. . ...z <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 /> ti�� <br /> Wood Stove (s) Franklin, other °;` <br /> �� <br /> Brand Name Model No. ,�; <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> f <br /> VENTILATION <br /> � No. Kitchen Exhaust ducted recirculating � cfm '� <br /> No. � Bath Exhaust ( ust be ducted outside) �_ cfm <br /> No. �_ Other�ns--�Locations �] cfm ; <br /> � <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MAIiSHAL) <br /> ``� Installation Removal <br />�:`- Fuel oil: gallons underground inside outside <br />�';sr; LP Gas: gallons <br /> Other Gas opening <br /> :� <br /> PERMIT FEE CALCULATION <br /> � 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> C�� �r`-k� x .0125 $ �pQ�. � <br /> - .� <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> `` Surcharge to each permit. ��Q,O�U x .0005 $ .� <br /> or $.50, whichever is greater (contract price) :K <br />:"y,."��,...:.-, <br /> f� <br />��, 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �� �; <br /> , <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pemutted `` <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 naterial, equipment, labor, or installat:�n are furn�shefl by :.�:e o�vaer, <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 /> ; <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 certifies that all statements made on this application are complete, true ;� <br /> and correct. v <br /> �; <br /> �' �. <br /> Applicant's Signature: Date: <br />:�� Approved By: • Date: F <br /> ,;, �� ' — *` �, � T _ .�� <br /> . -r. � :, <br /> _ _. � .. <br /> 3� ` �� ,�. t, �� � : � � � � � � � <br /> , <br /> , . , _ __ _ ... <br /> � - - .. ..: .. � . .. :;�.:� _ _ �,. � <br /> _,. . . <br /> .. . .r_ :�� :? t: , .. _ _.. . .a . . <br />