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��j .. �. � - ��. , , - � ,. � .x . . y- f j <br /> . . _ � . , a. , , <br /> . . . F.� '�\ . .. . �� � . ' <br /> 1 <br /> � WOOD BURNING EOUIPMENT � - <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue ;�K <br /> Factory Fireplace (s) Freestanding Masonry a, <br /> h� <br /> Wood Stove (s) Franklin, other ;�' <br /> Brand Name Model No. � <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. _;� <br />,..; VENTILATION h <br />��: No. Kitchen Exhaust ducted recirculating cfm }' <br />� No. Bath Exhaust (must be ducted outside) cfm �� <br /> ��� <br />;;;` <br /> No. Other Fans: Locations cfm <br />���' FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> "f Installation Removal �` <br />�� Fuel oil: gallons underground inside outside <br /> -�-- LP Gas: gallons <br /> �: <br /> Other Gas opening � <br /> d '� <br />����: PERMIT FEE CALCULATION <br />`,„,�; 1. 1.25% of Contract Price* or Minimum Fee 35.00 �,' <br />��° � C� �7 - cv x .0125 $ 3�j- c� � <br /> (contract price) <br />�`, 2. State Surcharge. ** Add the State Building C�e Division p, /�, s <br />}Y Surcharge to each permit. ( �7� '�`�`� x .0005 $ � v� � <br />�" or $.50, whichever is greater (contract price) '�� <br /> 3. Postage and Handling (Only mail-in applications) $ 1.50 <br />� . <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 37 ' `-f� <br />� � <br /> * CONTR.ACT 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 /> K-;� <br />�;;. customer for the work done. If any material, equipment, labor, or installation are fumished by the owner, _ <br />=.;;,;; tenant or any other party the reasonabie 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 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 and the regulations of the Minnesota <br /> State Building Code, and ce ifies that all statements made on this application are complete, true <br />� w� and correct. <br /> I <br /> � ' i �- �- � � <br />�" <br /> Applicant's Signature: � � Date: <br /> r�` Approved By: � Date: �'�� '� <br /> . <br /> 4 , _ ,; , . _ � <br /> - ;, �, '� � � .� � � � �� �� :� � � � � - ' r a � <br /> i.: � . . 3.. _ � � . . . . . .. ... . , . . � � . <br /> . . ..,. ' I ._.. ' ... . . . . . . . <br /> � <br /> t� ^ 1' <br /> �L.��IIk'.: ......4 ..:�: S '2 . � ' . .. . . . _ . �'� . ....l.. . ..w._- ... � . .. _.r <br />