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---�-r,.`---�-��,- <br /> � ; <br /> � �vr- � ,: , ` _ <br /> WOOD BURNING �QUIPMENT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Pactory 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 /> V�NTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. ;� I3ath Exhaust (must be ductecl outside) ��t� cfm � _ . <br /> No. Other Fans: Locations cfm <br /> FUEL STORAG� (MU5T B� APPROVED BY FIRE M�\RSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other ��r, �,�� � $� �= � Gas opening <br /> PERMIT F�E CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) � <br /> =�- � ��� . ��= x .0125 $ � <br /> �(contract price) `� <br /> 2. State Surcharge. ** Add ttie State Building Code Division a� <br /> Surcharge to each permit. x .0005 $ <br /> or $.50, whichever is greater (concract price) #' <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 _ <br /> 4. TO"TAL PERMIT rEE (Add lines 1-3 above) $ <br /> * CONTRACT PRICE or JOB COST mcans thc actual or estimatcd dollar amount chargcd for thc permittcd <br /> work including materials, labor, profit, and other fixed costs. It is the amount to be charged to ttie <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 �dded to thc 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 /> thc City may request the submission of a signed copy of the actual contract. <br /> ** Thc STnTG SURCIiARGE is .0005 of thc contract �ricc undcr $1,000,000 or $.50 - whichcvcr is <br /> grcater. For valuations over $I,000,000 call tlic Department of Inspectional Services for the price. <br /> The undersigned hereby applies to the City for issuance of a Meclianical Permit, agrees tc� 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 correct. <br /> �� <br /> Applicant's Signature: � Date: `� �%' 1 —`% � <br /> Approved By: Date: <br />