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. � <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 Exhaust ducted recirculating cfm <br /> No. Bath Exhaust (must l� ducted outside) cfm <br /> No. Other Fans: Locations cfm <br /> FUEL ST'ORAGE (MUST BE APPRO`�ED 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 .00 ��� <br /> �� x .0125 $ � <br /> ��ontract price) <br /> 2. State Surchar�e. ** Add the State Buildina Code Division <br /> Surcharge to each permit. ��) � x .0005 $ ��3 <br /> or $.50, whichever is greater ��ontract price) <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ -�56—' <br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �� ,'g;� <br /> * CONTRACT PRICE or JOB COST means t�e actual or estimated dollar amount charged for the permitted <br /> work including materials, labor, profit, �.d other fixed costs. It is the amount to be charged to the <br /> customer for the work done. If any materi�. equipment, labor, or installation are furnished by the owner, <br /> tenant or any other party the reasonable �{zt value of such items must be added to the estimated cost <br /> or contract price for pernut fee purposes. I�:he event that there is a dispute on the amount of the job cost, <br /> the City may request the submission of a s:`�ned copy of the actual contract. <br /> ** The STATE SURCHARGE is .0005 of�.�.e contract price under $1,000,000 or $.50 - whichever is <br /> greater. For valuations over $1,000,000 :�'1 the Department of Inspectional Services for the price. <br /> The undersigned hereby applies to the Ciri- for issuance of a Mechanical Permit, agrees to do <br /> all work in strict accordance with the ordinar�:es of the City and the regulations of the Minnesota <br /> State Building Code, and certifies that all stat�ments made on this application are complete, true <br /> and correct. <br /> i <br /> � <br /> Applicant's Signature: Date: / ��U <br /> Approved By: Date: Z-) `�� �o <br />