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4 .• , <br /> 4 & <br /> iI'l+ WOOD BURNING EQUIPMENT Poll 5 A-7 0 r .�!y /y • <br /> n Wood stove with flue <br /> . • Wood combination or add-on "-‘,0„,_,. <br /> Factory fireplace with flue ' <br /> Factory Fireplace (s) Freestanding Masonry <br />.. Wood Stove (s) Franklin, other <br /> Brand Naei,, __,, Model No. ' <br /> Mfg'r"`s Min., Clearances, side , rear , min. flue dia. <br /> ' Total <br /> VENTILATION A90 e 5 A-,(91` Af✓01X <br /> No. Kitchen Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm. �.. <br /> • No. Other Fans: Locations cfm ' ' <br /> Total ' <br /> t <br /> . FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) 1)45 4,eye- *?> <br /> nstallation Removal 44, <br /> Fuel oil: gallons _ underground inside ,f utside <br /> LP Gas: gallons <br /> . Other • . . Gas opening <br /> PERMIT FEE CALCULATION . <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> . 2 Zi C) 1. x .0125 $ . Z '75, 3 .) <br /> contract price) <br /> 2. State Surcharge. ** Add the State Building Code Division ' • <br /> Surcharge to each permit. e z� �t, c.-.,(7,:, x .0005 $ / / , a/ <br /> (contract price) <br /> or $.50, whichever is greater <br /> • 3. Postage and Handling (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ Z S e7.. ' <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, equipment, labor,or installation are furnished by the owner, <br /> if <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 /> I + 0+ The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is <br /> V` ' 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 l�and certifies that all statements made on this application are.complete, true <br /> 1 <br /> and correct_.... . • <br /> Applicant's Signature: T- �,,‘u,e4..."7- ._..Date: c- <br /> Approved By: . "Date:Date: r d <br />