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y i <br /> ' y � v <br /> WOOD BURNING EOUIPMENT <br /> Wood stove with flue . �� ' ' � "` <br /> `� <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 STORAGE (MUST BE 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 /> � $ <br /> J�'1_ } x .0125 JJ:. <�� C_� <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. "�C� � x .0005 $ � J�� <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handling (Only mail-in applications) $ 1�,0 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �j'�_(�' '�— <br /> �_.� <br /> * CONTRACT PRICE or JOB COST meaas the actual or zstimated dollar amount charged for the permitied <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 pernut 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 /> ** 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 /> .� <br /> State Building Code, and certifies that all statements made on this application are complete, true �� <br /> and correct. ,� <br /> % <br /> `-'� �- . , . � .. , ' <br /> , <br /> Applicant's Signature: ��'`� ,�� ;��� ����(i�� Date: .. �' �` <br /> , ,. <br /> Approved By: � Date: U � � <br />