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t# <br /> � <br /> v 1 <br /> �y <br /> Ra�, <br />�:;: <br /> � <br /> . :29 <br /> � <br /> WOOD BURNING EQUIPMENT -� <br /> Woc�d stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue •�` ` � ��; <br /> Factory Fireplace (s) Freestanding Masonry -r� <br /> Wood Stove (s) Franklin, other <br /> Brand Name Model No. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> Total <br /> ,.z <br /> :� <br /> VENTILATION <br /> No. Kitchen Exhaust ducteii recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> '�To. Other Fans: Locations cfm <br /> i Ul;ai <br /> � <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) � <br /> �r <br /> Installation Removal =��� <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> PERl��IT FEE CALCUI.ATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) `1 � � <br /> ���� x .0125 $ �2 ' `�'S <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code Division � <br /> Surcharge to each permit. `� x .0005 $ � ' �� � <br /> contract price) <br /> or $.50, whichever is greater <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br />��;; 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �'�- 1 <br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted ` <br /> work including materials, labor, profit, and ot�er fixed cu�cs. It :s ih� amouat to be charged to th� <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 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 STATE 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 />�1Y <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 thi� application are complete, true <br /> and correct. � � �- <br /> k.,:. � � -`� . Date: �b � � `cf S <br />� Applicant s Signature. <br /> Approved By: <br /> � Date: S� �0� �? ��� <br /> . :� <br /> �. <br />