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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 /> 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 /> iva. _� Bath Eu'�aust (must be dacted outside) cfm <br /> No. _� Other Fans: Locations ��,V��� �>c�r,�,�/��`' cfm <br /> Total <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> X LP Gas: gallons <br /> Other � Gas opening <br /> PERI�ZIT g'EE CALCiTLATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> �((�,C�C� � C>C� _ x 1.25 $ {��C� <br /> (contract price) <br /> 2. State Surcharge. ** Add the�tate Building Code Division <br /> Surcharge to each permit. l C�,U()(� � C�C� x .0005 $ 5�UU <br /> (contract price) <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ � ,� 1 • 5U <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted <br /> work including materiais, iaoor, profit, and o�er fixed costs. It is tt;e amount to be c�zrge�i 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 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 aznount 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 work in strict accordance ith the ordinances of the City and the regulations of the Minnesota <br /> State Building Code, and ce ' es that all statements made on this application are complete, true <br /> and correct. <br /> Applicant's Signature: �'`" Date: � -(�-��j <br /> Approved By: _ Date: <br />