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1 <br /> WOOD BURNING EOUIPMENT _ <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. S f��/� <br /> Mfgr's Min., Cle ces, side , rear , min. flue dia. ,f <br /> Total ; <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfin <br /> No. Other Fans: Locations cfm <br /> -------__�__ Total <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Cas: ballor.s <br /> Other Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.OU) <br /> ��C�i� x .0125 $ � � `J G� <br /> (contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division �, <br /> Surcharge to each permit. a�UC% x .0005 $ / ; �>�� <br /> (contract price) <br /> or $.50, whichever is greater <br /> 3. Posta�e and Handlin� (Only mail-ir. applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ;3� `�c� <br /> �` CONTRACT PRiCE or J(�B COST�u�►s t�e actuai �r es[uaat:ci uotlar a��ounc cna�ged for tne Fermitted <br /> work including materials, labor, grofit, and other fized costs. It is the amount to be charged to the <br /> customer for the work done. If any material, eqsipment, 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. ?n the event that there is a dispute on the amount of the job cost, <br /> the City may request the submission cf 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 �ver $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 /> � � <br /> Applicant's Signature: �/ �' � Date: <br /> Approved By: Date: <br />