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, � , <br /> � <br /> WOOD BURNING EQUIPMENT <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 E�aust ducted recirculating cfm <br /> No. Bath Exhaust (must be ducted outside) cfm <br /> No. Other Fans: Locations cfm <br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <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 /> ,�lL"C�. x .0125 $ ����.�G> <br /> (contract price) � <br /> 2. State Surcharge. ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ l G�Z._� <br /> or $.50, whichever is greater (contract price) <br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ � '7. ,���� <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 pernut 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 $1,000,000 call the Department of Inspectional Services for the price. <br /> The undersigned hereby applies to the City for issuance of a Mechanical Permit, agrees to do <br /> all work in strict accordance with the ordinances of the Ciry and the regulations of the Minnesota <br /> State Building Code, and certifies that all statements made on this application are complete, true <br /> and correct. <br /> i" <br /> Applicant's Signature:'-=�� / f Date: ���-- <br /> ��-i_G�_ <br /> Approved By: Date: <br />� � � ; �'�9iv��..{k�'4�-..i.Y f Xu.Y��...�E Vai`�"4 �4� - . : . _ ' r �« <br /> r�'��( ��,� ""' "`�? . �i!� +� �_e � c i;� � ' .��; � � � <br />�.���s �'1 ���$� ,(. ° �,t�� <br /> �.;;��, L.`� � F f.. y � �it � .�YS Y T � q . . y �'#� � '��"4 <br />�Y f4 ��Yz Jf N'- 9 '�'' �`r �i�5 �� ' . . ,s. . , <br /> ����� � ���° � •i��'�'.�i'���'��� ���}¢ �.� � e t� . . . _ . . � . <br /> .,� <br /> ����- Y YPff� �ibr u h1(f ''T{ � *Y. . 6 � �' ' � <br /> �..�. �.t. -�..y.� °� x,aW'/x ;,:', '�'iJ?': C � �"+ $r,. '.�g . . . :,. 4 'a_ .. M � '., .. <br /> � <br /> .. _ +R�+kt'aJA�a"�Y't 'htli��i`�lira��.,!Rn•4[.4�v:AiyeiYa����.� .. <br />