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�a t� °i� <br /> �_ . �.; <br /> ,}.�.��.�.,.�. _ <br /> , �:' ;�; <br /> �, . E� <br /> ��` � <br /> s. <br /> :� �: <br /> WOOD BURNING EQUIPMENT <br /> Wood stove with flue `� <br /> Wood combination or add-on <br /> `� <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 Min., Clearances, side , rear , min. flue dia. <br /> Total <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br />,� No. Bath Exhaust (must be ducted outside) cfm <br />�k� No. Other Fans: Locations cfm <br /> Total <br /> #`. FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> ,;1 Fuel oil: gallons underground inside outside <br /> LP Gas: _ gallons <br />�' Other Gas opening <br /> 3< <br />�' PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> �. -� 8 o x .0125 $ 23 y.'? j <br />�,` (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> �- Surcharge to each permit. CD "l 8 o x .0005 $ 3. 3 q <br />��= (contract price) <br /> or $.50, whichever is greater � <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 � <br />,;;: <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ��. ti� � <br />.�# <br />�j * CONTRACT PRICE or JOR 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 amoun[ to be charg�d to the :, <br /> customer for the work done. If any material, equipment, labor, or installation are furnished by the owner, ,a <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. 0.,` <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 /> 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 certi�es that all statements made on this application are complete, true <br />�h and conect. <br /> a� <br /> , <br /> Applicant's Signature����',''.���,1s�t� llate: Z�?- =� <br /> ��� <br /> Approved By: �� Date: �- � � �w <br />� , ._.a� 9; <br /> r <br /> �:. <br />