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. _ J _ ' _ �� �- ��-c� � � _ �,AA �-- ' . <br /> W��l <br /> BURNING E UIPMENT � ? ��v'`-" <br /> Wood stove with flue ���- .�E��X _ <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 , mi.n. flue dia. � <br /> Total <br /> VENTILATION <br /> No, Kitchen Exhaust ducted recirculating �� <br /> No. Bath Exhaust (must be ducted outside) �� <br /> No. Other Fans: Locations �� � <br /> T�,`�1 <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSH�.L) <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.'LS% of Contract Yrice�` or 1�linimum Fee ($3�.a0) <br /> _--����� x .0125 $ <br /> (contract price) <br /> 2. State Surchar� ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ �� �b <br /> (contract price) <br /> or $.50, whichever is greater <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add li.nes 1-3 above) � �?��— <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollaz amount charged for the perm.itted <br /> woric inciuding a�acerials, laoor, proiit, and o�ner nxed cosu. It is ihe amounc 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 markes value of such items must be a�ded to the estimated cost <br /> or contract price for perm.it fee purposes. In the event thac there is a dispu[e on the amount of the job cost, <br /> the City may reqnest the submission of a signed copY of the actual c,onuact• <br /> ** The STATE SURCHARGE is .0005 of the contract price under $1,OQ0,000 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 Perm.it, agrees to do <br /> all work in strict accordance with the ordinances of the City and the re�gula�o��e�Meinneso�e <br /> State Building Code, and certifies that all statements made on this app P <br /> and correct -__ __ � . <br /> _ � _ -- ..::. Date: ��� <br /> _ Applicant's Signa <br /> _ . Date: <br /> Approved By:� ' <br />