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t � <br /> 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 c����.(���,� ���Ty��.�� Model No. <br /> Mfgr's Min., Clearances, side , rear , rnin. flue dia. <br /> Total <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <br /> Total <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 /> PERMI�' FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> ,u� � _ <br /> x 1.25 $ �`�;��- <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code I��vi�i��s=���� <br /> Surcharge to each permit. /J c i ` �z� ""�x D005' $ . � '�- <br /> (contract pric � �' � <br /> 3. Posta�e and Handlin� (Only mail-in applicat�ians) . � � ' ' $ �� <br /> 4�� <br /> 4. � TOTAL PERMIT FEE (Add lines 1-3 above) ; .._.4 �„ „ $ :�� �5 <br /> * 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 fumished 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 pernut fee purposes. In the event that[here 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 Mi.nnesota <br /> State Building Code, and certifies that all statements made on this application are complete, true <br /> and correct. <br /> � <br /> Applicant's Signature: ���,���.- �i� .<'��4 Date: C.- u� <br /> Approved By: Date: <br />