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.,n� <br /> WOOD BURNING EQUIPMENT <br /> Wood stove with flue <br /> Wood combination or add-on � <br /> � <br /> Factory fireplace with flue t�� <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 Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <br /> FUEL STOI2AGE (MUST �3E APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> 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 Min' um Fee 35.00 � <br /> /1�� ,O° x .0125 $ _ � . _ <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division �7C� <br /> Surcharge to each permit. x .0005 $ <br /> or $.50, whichever is greater (contract price) <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT PEE (Add lines 1-3 above) $ �7, � <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 ror tne worx done. Ii u►y material, e;yuipment, labo:, ar installation a.c fi:rr.ished by che ownPr, <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 S'I'ATE 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 /> x;' <br /> The undersigned hereby appl i�s to the City for issuance of a Mechanical Permit, agrees to do ?°:� <br /> all work in strict accurc!anc with the ordinances of the City and the regulations of the Minnesota <br /> State Building Code, and ce ' �ies that all statements a e on this application are complete, true <br /> and correct. <br /> Applicant's Signature: Date: — —�co <br />�� � Date: �� �� <br />�� Approved By: <br />�:: <br />�� <br />�,... <br /> <. . . <br /> ,., . ; ,. , . , :, ,s <br /> �_ . ,_"- /_ . i' F._ - <br />