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. . - . <br /> __ .. - t <br /> - . . . . . --- <br /> WOOD BURNING EQUIPMENT - <br /> - - Woad stove with flue . � <br /> - Wood combination or add-on <br /> Factory fireplace with flue � � � <br /> - Factory Fireplace (s) Freestandi.ng Masonry � <br /> Wood Stove (s) Frankiin, other � <br /> Brand Name Model No. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> Total <br /> VENTILATION <br /> No. Kitchen E�aust ducted recirculating �� <br /> No. Bath Exhaust (must be ducted outside) �� <br /> No. Other Fans: Locations �� � <br /> . Total <br /> FUEL STORAGE (MUST BE APPROVED BY FIltE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> I,p Gas: gallons <br /> Other Gas openi.ng <br /> PERMIT FEE CALCULATION <br /> l. 1.25% of Contract Pricer or iYlinimum Fee ($35•a01 <br /> i C�z�- "`' x .oi25 $ �J� <br /> (conuact price) <br /> 2. State Surchar�e. ** Add the State Building Code DiXisio�5 $ � <br /> Surcharge to each permit. � <br /> (contract price) <br /> or $.50, whichever is greater 1.50 <br /> 3. Posta�e and Handlin� (Only mail-in applications) � <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ��� ��' <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the perm.itted <br /> work including materials, labor, profit, and other fized cosu. It is the amount to be charged to the <br /> customer for the work done. If any ma[erial, equipment, labor,or installation are fumished by the owner, <br /> tenant or any other parry the reasoaaoie marice� value a:suc� ite� m�.�..�t 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 /> ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or �.SO - whichever is <br /> onal Services for the rice. <br /> greater. For valuations over$1,000,00� call the Department of Inspecti P <br /> The undersigned hereby applies to the Ciry for issuance of a Mechanical Permit, agrees to do <br /> all work in strict accordance with the ordinances of the C1tY and the regulations of the Minnesota <br /> State Buildi.ng Code, and certifies that all statements made on this application are complete, true <br /> �d �o�t __-- __ ,,, �����9 � <br /> . . _ . , , <br /> _ �_ .:. Date: <br /> _ Applicant's Signature: � ' <br /> ._ ._ Date: <br /> Approved By:--:- : � <br />