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r ' <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 /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <br /> FUEL STOFtAGE (MUST �E APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> , R: <br /> = ';_ �' x .0125 $ :�'� _ <br /> �car.tract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> � � <br /> Surcharge to each permit. �'� • ' x .0005 $ � <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handlin� (Orily mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT TEE (Add lines 1-3 above) $ �r�l. C���� <br />�� <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br />�`.` <br />��,�'�j work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the <br /> ' customer for the��erk done. If a.ny material, equipment, labor, or installation are furnished by the owner, <br />�i 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 S'fATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is <br />�:'',:?; <br /> greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price. <br />"r�'' The undersigned hereby appli�s to the City for issuance of a Mechanical Permit, agrees to do <br /> _� <br />`�:`` all work in strict accurc!ance with the ordinances of the City and the regulations of the Minnesota <br /> State Building Code, and certifies'that all stateme s made on this application are complete, true <br /> "' and correct. <br />�:. <br />�, i i <br />�-� Applicant's Signature: ' /� � Date: /� �� � � <br />�, . ;; � ,c�. <br />��. Approved By: Date: � cL C� <br /> r�' <br />�r' , <br />�� . <br />�,.. <br /> ; . . <br /> , ` ` , . ` , <br /> , �� <br /> . <br /> � . ;�� , <br /> ��� ; = a a _ : � <br />