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11-03-1998 d_01PM FR��1 FIRESIDE CORNER 612 633 8884 P_ 3 <br /> , • <br /> � WOOA BUR.NING L3J� I� <br /> � Wood stove with flue ' <br /> Wood combination or add-on <br /> Faccory fireplacc with flue <br /> Factory Fireplace (s) Freesranding Masonry <br /> Wood Stove (s} Franl:Iin, other <br /> �,�a�T�e Model No. <br /> Mfgr's Min., Clearances, side , rear , mzn. flue dia. <br /> Totai <br /> vErrrr�,arro�v <br /> No. Kischen Exbaust ductecl recirculati,ng cfm <br /> No. Bath Exbaust {must be ducced outside) cfm <br /> No. Other Fans: Locations �� <br /> . Total <br /> FI3EL STORA,G� (MUST BE APPROVED BY FIRE MARSHAL) <br /> Instaltation Removal <br /> Fuel oil: gallons underaround inside outside <br /> LP Gas_ gallons <br /> Other Gas opening <br /> PE FEE C C'CTlATIO�T <br /> 1. ].25% of Contract Price"` or lv�inimum Fee 35.00 <br /> / m.�� — x .a125 � .�xa <br /> � ' (c:ontract price) <br /> 2. �,tate Surchar�e_ ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 � •s^ <br /> (conuact price3 <br /> or 5.50, vvhichever is greater <br /> 3. ostaae d HandIin� (Orily mail-in applications) $ I.50 <br /> 4_ TOTAL P�RMIT FEE (Add Iines 1-3 above) $ _?7_�r _ <br /> * CONTRACT PRICE or 3�B COST means ihe actua� or escimaced dollar�ount cbargcd for the permiLcal <br /> ' work including macerials, 2abor, profii, and other fued coscs. li is tbe amount �o be charged io cho <br /> customer for the work done_ If any mactrial, equipmeat, labor,or iascallation are furnishra by thc owner. <br /> tenaat or any other parry tbe zeasonable markec value of such icems:aust be added to rbc cstimaced coss <br /> or contract price for pumit fee purposes. J�a Yht evarc thac there is a dispuce on the a�oaou.nc of the job cost, <br /> the Ciry may zequest the submission of a signed copy of the accual convacc. <br /> ** Tt�e STATE SURCHARGE is .0005 of tb�e coairact price under 52,000,000 or 5.50 - whict�cver is <br /> greacer. For valuauons o�er SI�000,000 call the Depanmant of Iaspectional Ser�+ices for the price. <br /> The und�rsigned hereby applies to the Ciry for issuance of a Mechanical Permic, agrecs ta do <br /> aII wor�: zn stzict acc��dance wich the ordinances of the City and the regulations of the Mi�nesoca <br /> Stace Buildizig Code, and ceztifies that all scacemenrs made om this application az�e complete, uue <br /> and correct. <br /> Applicaat's Si�nature: Date: �319� <br /> APProved By: Datc: <br />