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�- <br /> �� � <br /> ��B BURNI?�1G EQUIPMENT <br /> V�'ood 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 /�J ceJ��!c_� ,� Model No. ( !� � � <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> VENTILATION <br /> No. Kitchen E�aust ducted recirculating cfm <br />� No. Bath E�chaust (must be ducted outside) cfm <br />;�;; <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 /> r,2 ���o�o=� x .0125 $ 3.S� D� <br /> (contract price) <br /> 2. State Surchar� ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ � � U �� <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> - 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 3 ;', � U <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <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 aze 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 wark in strict accordance with the ordinances of the City and the regulations of the Minnesota <br /> State Buildin' Code, and certifies that all statements made on this application are complete, true <br /> and correct. <br /> Applicant's Signature: ��. �' �, Date: �' ( ' �c' <br /> Approved By: Date: <br /> , . �;: ..: . , . , <br /> ; , . ; ., � . .,.. <br /> : ... :�:. ; - <br /> ` ., : <br /> . <br /> . .. . _ .. <br /> � _ ._. .._ : . � _ _ _ <br /> _ � . _ . . ... --- .. . . . .,.. � _._�,_�.. <br /> . <br />