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d-03-1998 10:33Ah1 FROM FIRESIDE GORI�R 612 633 8884 P. 3 <br /> - , � <br /> � � <br /> i <br /> I <br /> � <br /> ; W OD '� , <br /> � wood stovc with flue - <br /> � Wood combination or add-on <br /> ; �a�tory firep�arx with flue <br /> � �_ Factory Fireplace (s) Freestanding Masonry <br /> ! �_ �Jood. Siove (s) �k4t N F:� ffSr��Franklin, osher <br /> � ������ ~ Model No. <br /> j Mfgr's Min., Clearaaces, sidc�, rear , mi�n• flue dia. <br /> Total <br /> VENTn�ION <br /> i No. I�itch�a Eacbaust � ducted recirculatiag cfm <br /> ` No. Bath Exhaust (must be ducted outside) cfm <br /> � No: Orher Faus: Locauons cfm <br /> ' To�cal <br /> � <br /> i <br /> ' FUEL STnRAGE (MUST BE APPROVED BY FrRE MAR.SHAL) <br /> ! Installacion Rcmoval <br /> � Fuel oil: gal]ons underground inside ouuide <br /> j LP Gas: galloas <br /> i Oth�er Gas opening <br /> � <br /> � P E IQN <br /> � 1. 1.2�k of Co�tra.ct P_z'�ce* or Tvtinimum Fee (S35.fl41 <br /> � ��t7�.a� _ x .OI25 � .��.c�� <br /> i ' (contract price) <br /> ' 2, rate tircharq� ** Add rhe State Building Code Division <br /> ISuxchargc to cach pernut. ���oA a� x, .0005 S •t o <br /> � (contracz pricc) <br /> I or 5.50, whichever is grcatez <br /> i 3. Postage and I�and� t4m�y mail-in applications) S _ -�- <br /> I 4. 'Z'OTAL PERNIIT FEE (Add dines 1-3 above) � <br /> f <br /> � "` CONTRACT PRICE or JOB COST meaas the actual or estimated dollar amvuat chargcd for dae germined <br /> I work including materials, 2abor, profit, a�d ocher fi� eosu. Ii is tae uonuat co be charged to iho <br /> cuscomer for ebie work done. If auy maurial, equipment, laboz,or icscalla�ion az�c furaishsd by ihe o�er, <br /> � tenaac or aay otties parry the reasonsble marl:et vale�e of sueh items must De a,ddrti to the estimated cost <br /> � or contrac�c price.for permit fee puiposcs. Ia the eve�c that tbere is a dispuce on the amounc of cbe job cosc, <br /> ? tbe Ciry may request rhe submission of a sigaed copy of tbe sccua� conuaec. <br /> i <br /> � "'" The STATE SURCHARGE is .00QS of the conmact price woder 51,000,000 or 5.50 - whichever is <br /> � greuer. k'or va�uatioas over 51,000,000 call the Depaztment of I�aspeccioual Scrvices for the price. <br /> i <br /> � The undersigned hereby applies to th,e Ciry for issaance of a Mechanucal Permit, agrcLs to do <br /> � alI wark in strict accordance with the ordinances of the City and the re�ulations of the Minnesota <br /> � Scate Building Code, and cextifies that all stacements made on this application are complete, true <br /> i <br /> ; . and conect. <br /> � <br /> � Applic+nc's Si�nature: Date: <br /> � <br /> � Approved By: Date: <br /> � <br /> I <br />