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WOOD BtiR.�v'IlVG EQUIP���'T' <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue <br /> Factory Fireplace (s) Freestanding Masonr}� <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 /> No. Other Fans: Location.� _ __�_____ _ cfm <br /> _:':::��i <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MAK��-�AL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> PERMIT FEE C_4LCULATION <br /> 1. 1.25 0 of Contract Price* or Minimum Fee ($35.00) � �' <br /> f� 7 C,� C�, e-� x .o�2s � ; 7. ���t� <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ <br /> (contract price) <br /> or $.50, whichever is greater <br /> 3. Postaae and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERNIIT FEE (Add Iines 1-3 above) $ �,�-�.� ; �^S- <br /> * C'O��'7'RAC'T PRICE or JOB COST me�s the act.,a] or estimated dollar amount charged far the permitted <br /> work includin� materials, labor, profit, and otner fixed costs. It is the amount tu be chareed tu �e <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 permit fee purposes. In tbe event that there is a dispute on the amount of the job ccst, <br /> the Ciry 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,�00 or �.50 - whichever is <br /> greater. For valuations over �1,000,000 call the Department of Inspectional Services for the pnce. <br /> The undersi�ned 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 Cit�� and the regulations of the Minnesota <br /> State BuildinQ Code, and certifies that all statements made on this application are complete, true <br /> and correct. <br /> � ' � � G <br /> Applicant's Signature: , ,���;,, .�� �Date: -� <br /> / � <br /> Approved By: Date: <br />