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� x . <br /> WOOD BURNING EQUIPMENT <br /> Wood stove with flue <br /> Wood combination or add-on <br /> Factory fireplace with flue <br /> ��fi .�� t/ 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. _�t i <br /> VENTILATION <br /> No. _� Kitchen Exhaust 1 ducted recirculating cfm <br /> No. �_ Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <br /> FUEL STO�tAGE (MUST RE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons � <br /> Other Gas opening <_� <br /> ;:$ <br /> �. <br /> PERMIT FEE CALCULATION � <br /> l. 1.25% of Contract Price* or Minimum Fee ($35.00) ��' a-'� <br /> x .0125 $ -- � �� <br /> (contract price) � �5�' • �'Z� � <br /> 2. State Surcharge. ** Add the State Building Code Division ���8 <br /> Surcharge to each permit. x .0005 $ ��' <br /> or $.50, whichever is greater (contract price) <br /> 3. Posta�e and Handling (Only mail-in applications) $ 1.50 s�� <br /> 4. TOTAL PERMIT PEE (Add lines 1-3 above) $ '� <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 /> 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 /> =�N <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 /> <`:g <br /> The undersigned hereby appl i�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 of 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: � Date: (�� l� �� <br /> . <br /> Approved By: Date: <br />