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! <br /> WOOD BURNING EQUIPn�ENT <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 /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. / Bath Exhaust (must be ducted outside) cfm <br /> No. / (3�ker�€'^ans: Locations cfm <br /> �Y� <br /> FUEL �T(J��iAG� (IviiJST �E AFPRUVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside , <br /> LP Gas: gallons � � <br /> Other - Gas opening ,, p� �' <br /> i <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee (�35.00) <br /> ,. a , , .� <br /> �,� ,-f.;, 1 s�%��'��=-" x .0125 $ �"`'s�� � ., <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division - o� <br /> Surcharge to each permit. x .0005 $ -�:T�' <br /> or $.S�J, which�ver is greater (contract price) 0 <br /> / � � <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 /�� <br /> 4. TOTAL PERMIT PEE (Add lines 1-3 above) $ ��-�G"".� •- �,L> <br /> �:%��G� <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 for the work done. If any material, eq_uipment, labor, or installation are furnished 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 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'fATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is <br /> greater. For valuations ovcr $1,000,000 call the Department of Inspectional Services for the price. <br /> The undersigned hereby appl i,:� to the City for issuance of a Mechanical Permit, agrees to do <br /> all work in strict accurc!ance 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 /> ; ,_ <br /> Applicant's Signature: 1'`'`�- I � ' 't--� Date: I � D•z <br /> Approved By: Date: <br />