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_ ' • � <br /> WOOD BURNING EQUIPMENT _ . _ `- - <br /> Wood stove with flue � <br /> Wood combination or add-on <br /> Factory fireplace with flue � � <br /> . Factory Fireplace (s) Freestanding Masonry - <br /> wooa sto�e (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 Exhaust ducted recirculating �� <br /> No. Bath Exhaust (must be ducted outside) �� <br /> No, Other Fans: Locations �� � <br /> Total <br /> FUEL STORAGE (MUST BE APPROVED BY FIlZE MARSHAI-) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> L,p Gas: gallons <br /> Other Gas opening <br /> . PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.001X 0125 $ <br /> j�c-' <br /> (contraci 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 /> * CONTRACI'PRICE or JOB COST means the actual or estimated dollar amount charged for the perm.itted <br /> work including materials, labor, profit, and other fiaed costs. It is the amount 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 o[her 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 City may request the submission of a signed coPY of the actual contra��- <br /> ** The STATE SURCHARGE is .0005 of the contract price under $1,OQ0,000 or $.50 - whichever is <br /> greater. For valuations over $1,000,00� call the De'Partment of Inspectional $ervices 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 ordinanem n mad on this applic.�atio are omP��t�e <br /> State Building Code, and certifies that all <br /> and correct -- _ � � � � ' <br /> - -_ _�___ � .- � Date: - �'.� ` <br /> _ Applicant's Signature: <br /> ` Date: <br /> . APProved By:-.._:: ✓ � <br />