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. : � <br /> W04D BURNING EOUIPMENT <br /> Woc�d stove with flue <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 /> Total <br /> VENTILATION <br />. No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations �� <br /> . Tot� <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 Minunum Fee ($35.00) � <br /> aR p � � x .0125 $ �JJ`' ,Q� <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ � ,y� <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 lines 1-3 above) $ � r7 ��O <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> wor� :nclLding �±±ate*ia1.s, lah�r, pmfit, and other fued costs. It is the amount to be charged to the <br /> customer for the work done. If any material, equipment, labor,or installation aze furnished 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 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 an+d the regul ' of the Minnesota <br /> State Bui�ding Code, and certifies that all sta ents e on ihis appl' atio are complete, true <br /> and correct. . <br /> Applicant's Signature: Date: C1 ���-� <br /> A�rroved By: <br /> � ' Date: bb � � <br />