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� <br /> _ . _ _ . - . . . -�. <br /> _ WOOD BURNING EQLTIPMENT -- <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 Model No. <br /> Mfgr's Mi.n., Clearances, side , rear , min. flue dia. � <br /> Total <br /> VENTILATION <br /> No. Kitchen E�chaust ducted recirculati.ng �� <br /> No. Bath Exhaust (must be ducted outside) �� � <br /> No. Other Fans: I.ocations �� - <br /> . Total <br /> FLTEL STORAGE (MUST BE APPROVED BY FIlZE MARSHAI-) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas openi.ng <br /> PERMIT FE� CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.001 �,;�_ <br /> /��°`= x .0125 $ —'-' <br /> (contract price) <br /> 2. St�te Surchar�e. ** Add the State Building Code DiXisio�5 $ ��� <br /> Surcharge to each permit. <br /> (contract price) <br /> or $.50, whichever is greater ��� <br /> 3. Posta�e and Handlin� (Only mail-in applications) � � � �o <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) � ' <br /> * CONTRAC'I'PRICE or JOB COST means the ac�.::�t or estimat� c�olla-�a�otnt chargeci for the permitted <br /> work including materials, labor, profit, and other fized costs. It is the amount to be charged to the <br /> � customer for the work done. If any ma�erial, equipment, labor,or installation are fiunished 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 /> ** The STATE SURCHARGE is .0005 of the contract price under $1,Q00,000 or $.50 - whichever is <br /> greater. For valuations ovez $1,000,00� call the DePa�ent of Inspectional $ervices for the price. <br /> The undersigned hereby applies to the City for issuance of a Mechanical Perm.it, 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 agplication are complete, true <br /> � and correct. __�.______ � : <br /> . _ . -.' = .." v' Date: d7 iJ <br /> _ Applicant s Signature: , <br /> :. Date: <br /> Approved By:- -.` ' <br />