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---�---.�. _,F�-- ; --�- �, .. _.. � �n;_ . , . <br /> WOOD BURNING E�OUIPMENT <br /> Wood stove with flue - <br /> Wood combination or add-on �'��'��`��°;: ��., �. <br /> Factory fireplace with flue �'�"�;+,�� t ���;�, ,. <br /> _ ,� � ,�� � <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 />}'' VENTII,ATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath E�aust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <br />�. <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,� x .0125 $ _.�J, oz� <br /> (contract price) <br /> ,; <br /> 2. State Surchar� "* Add the State Building Code Division <br /> Surcharge to each permit. / � <<l <br /> �� _ ' x .0005 $ ,� <br /> ' � ' _ or $.50, whichever is greater (contract price) _- <br /> 3. Posta�e and Handling (Only mail-in applications) $ 1.50 <br />``` 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 3 '7� -- <br />� <br />��` . <br />��6 * 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 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 amount of the job cost, <br />�'; the City may request the submission of a signed copy of the actual contract. <br /> a`' _- <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 certifies that all statements made on this application are complete, true <br /> and conect. <br /> ���� � � � <br /> Applicant's Signature: � ' � Date: '�`���`r� <br /> Approved By: Date: ��1�, �1� <br />