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. ' „� <br /> , � <br /> �'40I� BUItNING EQI.�'NI�ENT . <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue <br /> Factory Fireplace (s) Freesianding Masonry <br /> Wood Stove (s) Franklin, other <br /> �r�nd Name Model No. <br /> Mfgr's Min., Clearances, side , rear , rnin. flue dia. <br /> Tatal <br /> �I�1�'I�,A�'I4TMt <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath E�aust (must b� du�ted outside) cfm <br /> I�To. Other Fans: Locations �� <br /> Total <br /> FITEL ST�1��� (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oiL• gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas open:ng <br /> �E�IT �� C�CULATI(�i`1 <br /> l. 1.25�o of Cortract Price* or Mia�i e�rn Fe� $35.04 <br /> _ ��' x .0125 $ �GI.,�'�_ <br /> (contraci price) <br /> 2. State Surchar�e. ** Add the State uilding Code Division <br /> Surchar�e to each permit. (% "� x .0005 $ ��� <br /> (contract price) <br /> or $.50, whichever is greater <br /> 3. Posta�e and Handlina (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �( <br /> * CONTRACT PRICE or Ja�COST means the actual or estimatetl dollar amount charged for the perm:�tted <br /> work including materials, labor, proftt, 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 fumished by the owner, <br /> tenant or any other parry 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 Ciry 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 vaivations over $1,000,000 call the Department af Inspectional Services ior the price. <br /> The undersigned hereby applies to the City for issuance of a Mechanical Pernut, 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 certi�es that all statements made on this application are complete, true <br /> and correct. <br /> A.p�licant's Signature- � Date: ul-�-0� <br /> Approved�y: Date: <br />