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� <br /> . , � <br /> WOOD BURNING EQUIPn'IENT <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. Other Fans: Locations cfm <br /> FU�L STOFtAGE (MUST �3E APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons � <br /> � <br /> Other Gas opening <br /> PERMIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> � � �t��;� X .oi2s � � d�'�^��� <br /> (contract �rice) <br /> 2. State Surchar�e. ** Add the State Building Code Division <br /> Surcharge to each permit. �j�;��j�; x .0005 $ <br /> 1 � <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �,��,c�,� <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollaz 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"rATE 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 appli�;s 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 o►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: -J�;��C�_����c�, Date: ������4 <br /> Approved By: Date: <br /> A:,l <br />�i�� <br /> f.. . . ' . .. ' i. - . . . .. ' . .. . . - � ��y1 <br /> _ � � — . . .. . .. . � . . - <br /> , , .. � . ��..� � . . � . . . : <br /> � . . . _ . ,� .. . . . � :. <br /> ,y.�. ,. . r . � ' <br /> 7 � .. � � ' . . � • •. � � � . � . <br /> aia�k'.wS..;._ i., d<_tu3..��� ...' . . �.. . W ��eR3t,._ .... . �-- :� - �� . � . . . .... . . . .... ��.�� , _ �...:: .� . , ..:'.�a� !�t't' ._ <br />