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s ' � <br /> WOOD BURNING EQUIPMENT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue <br /> r/��'actory Fireplace (s) Freestanding Masonry <br /> Wood Stove (s) Franklin, other <br /> Brand Name f�a.�/��t�r Model No. C�C. �C�S�T — �� <br /> Mfgr's Min.,�Clearances, side , rear , min. flue dia. <br /> V�NTILA'TION <br /> No. Kitchen �xhaust ducted recirculating cfm <br /> No. Bat11 Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <br /> rU�L S'I'ORAGE (MUST BE APPROVED BY FIRL MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons =� <br /> Other Gas opening `#' <br /> �§ <br /> P�RMIT FEE CALCULATION ' <br /> 1. 1.25%o of Contract Price* or Miniinuin Fee ($35.00) ;:,�; ��C+ <br /> x .0125 $ ' � <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division �+�; <br /> Surcharge to each permit. x .0005 $ /� <br /> or $.50, wl�ichever is greater (contract price) <br /> 3. Posta�e and IIandlin� (Only mail-in applications) $ 1.50 _ <br /> 4. 'fOTAL PERMIT PEE (�1dd lines 1-3 above) $ %'��,�"- <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar a�nount chargcd for thc perniitted :�� <br /> work including materials, labor, profi[, and other fixed cos[s. It is the amount ro be charged ro the �� <br /> customer for the work done. If�ny materill, equipment, labor, or installation are furnished by the owner, � <br /> icn�in[ vr aiiy other p��iy it�c re�tsonabic rnati:ci value ui:,ucli iteins niust �e addeu to iiie estimateti cusi <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 /> � <br /> � <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 correct. � <br /> ` � 1 . �� t�/ �;`� <br /> A��I1C111t's Signature: ( .� ��(il(i'��— Date: ' l - <br /> Approved By: Date: <br />