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��: <br /> <;;� <br /> � , . . ,�s <br /> ���� <br /> ;� <br /> ;;%� <br /> WOOD BURNING EQUIPMENT �� <br /> Wood stove with flue � <br /> nf� <br /> Wood combination or add-on <br /> Factory fireplace with flue � � <br /> Freestandm Masonry �'' <br /> Factory Fireplace (s) g <br /> Wood Stove (s) Franklin, other <br /> Brand Name Model No. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> Total � <br /> � <br /> �� <br /> VENTILATION � <br /> T1o, Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm � <br /> No. Other FarW: I.ocations cfm ` <br /> � <br /> Total <br /> K; <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) � <br /> � <br /> Installation Removal �' <br /> Fuel oil: gallons underground inside outside � <br /> � <br /> LP Gas: gallons <br /> Other Gas opening <br /> 8. <br /> PERMIT FEE CALCULATION <br /> 1. 1.25%o of Contract Price* or Minimum F�e ($35.00) � ` <br /> �3�s�'� x .Ol'25 $ �/� � Cr� r <br /> (contract price) �. <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surchai•ge to each permit. � , ` � x .0005 $ / , �(� k <br /> (contract price) � <br /> or $.50, whichever is greater ; <br /> 3. Post�,e and Handlin� (Only mail-in applications) $ 1.50 ? <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ � �', 3a <br /> * CONTRACT PRICE or JUB COST means the actuai or escimaiecit doiiar�o4ni c;arged :or the pe.�:tted <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 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 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 /> ** 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 /> � <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 /> Applicant'sSignature: �^,�/ ! _ Date: ��2— — --���- <br /> Approved By: `" � Date: l <br /> _#� <br /> �� <br />