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WOOD BURNING E�QUIPMENT <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 Min., Clearances, side , rear , min, flue dia. <br /> A <br /> R <br /> VENTILATION <br /> No. �_ Kitchen Exhaust � ducted recirculating cfm <br /> No. �_ Bath E�chaust (must be ducted outside) `� cfm � <br /> No. Other Fans: Locations cfm <br /> FUEL STORAGE (MUST BE 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 /> l. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> � � <br /> � �bd x .0125 $ _ ��-J� <br /> (contract price) <br /> 2. State Surchar�e. �`* Add the State Building Code Division <br /> Surcharge to each permit. rj G p� x .0005 $ 3 .•So <br /> or $.50, whichever is greater (contract price) _- <br /> 3. Posta�e and Handling (Only mail-in applications) $ r:��- �, G�'' <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ cj'a , �� � �� <br /> ; <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pernutted <br /> work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the <br /> customer for the work done. If any material, equipment, labor, or installation are fumished 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 pemut 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 $�1,000,000 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 certifies that all statements made on this application are complete, true <br /> and correct. <br /> Applicant's Signature: � Date: e / �: rJ � <br /> � <br /> � <br /> Approved By: ���n�(�/Y� Date: <br /> z , . _ . �,.: , . . ._ . , <br /> , , : ..,.. . . : .,. _ t. . . „ . , :.. . <br />