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� <br /> WOOD BURNING �QUIPM�NT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Pacrot-y fireplace with flue <br /> Factory Fireplace (s) Freestanding Masonry <br /> Wood Stove (s) Franklin, other <br /> Brand Name Model No. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> VENTILATION <br /> �� No. Kitchen �xhaust ducted recirculating cfm <br /> No. Bath Exliaus[ �must b�, ducted o;�tside) ci�ir. <br /> No. Other Fans: Locations cfin <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuei 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) � `� ` " �` <br /> ��(%Of, c-i' x .0125 $ <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to eac}i permit. x .0005 $ <br /> or $.50, whichever is greater (concracc price) <br />� ' 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br />�.., — <br />�.� 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ <br /> ' CON'TRAi,i i i I�E ar JCL CO�T n:car,s thc ac;uat !)I'rcfim�f�r] �lnll�r amrnii�t chargccl for ihc permittcd <br /> work including materials, labor, profit, and other fixed costs. It is thc amount to be chargcd to thc <br /> customer for the work done. If any material, equipmen[, labor, or installation are furnished by the owner, <br /> tenant or any othcr party the reasonable market value of such items must be added ro 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 requcst the submission of a signed copy of[he actual contract. <br /> ** The STnTE SURCIIARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is <br /> grcater. ror valuations over $1,000,000 call dic Department of Inspectional Scrvices for the price. <br /> The unclersigne� hereby applies to the City for issuance of a Mechanical Pertnit, 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 a ' tatements made on this application are complete, true <br /> , <br /> and correct. <br /> Applicant'sSignature: Date: / � �d � <br /> . <br /> Approved By: Date: e�/��/�_ <br />