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_ �t`„ . . . .. .. ... :. .. , (.yf <br /> f <br /> i <br /> /'. <br /> �V <br /> `y1; <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 J, f <br /> '- Brand Name Model No. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br />�� VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br />'- No. Bath Exhaust (must be ducted outside) cfm <br />�;; <br /> No. Other Fans: Locations cfm <br /> 7 �� <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) �`�' <br />� Installation Removal <br />'.�t 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) p�� j* <br /> ��p . O O x .0125 $ J� ,� <br /> , �' (contract price) `.' <br /> �; <br /> ' 2. State Surcharge. ** Add the State Building Code Division ;; <br />{� �;. Surcharge to each permit. x .0005 $ . �0 - <br /> `� or $.50, whichever is greater (conuact price) 'J <br /> �,�.sLSL p�c1C <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ d �� <br /> � 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �� ;Z� � <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 aze 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 /> f 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 /> , <br />� all work in strict accordance with the ordinances of the City and the regulations of the Minnesota <br /> R ;:,f;� <br /> �,��°` State Building Code, and certifies that all statements made on this application are complete, true <br /> ;�° and correct. <br /> s� </ <br /> Applicant's Signatur • Date: �� <br /> � � �, ., Approved By: Date: <br /> t f,, <br /> b: ��i:' <br /> � �. <br /> �� � ,� � .. J � '<� <br /> E . ... . \ . . � .. . . � . .. <br /> 1 S' <br /> . r ti �... � �� _ <br /> p- . ., . =� , - . � <br /> ", <br /> .r <br /> .� p .� , - . , . . . . .. .n,. � � � r <br /> . <br /> 3 <br /> . . ' .. w .:( i. u.._.'. ... . - �A�r:.�. . . � .�'�.- i. ..�. .-....::::: ... . ...:. .__:Si.al' . <br />