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�_:�� �. ,- . <br /> _ . , �. �� .. <br /> , � k'� � . ' / , �.. , . <br /> . - . � � . . . .. , �t . . . <br /> , . .. . „ �.. . . . . <br /> ,. . . � ., �.a _ . <br /> . <br /> � , . .. '.. „ .. . <br /> , ._ .. --, . .. . . _ - ..- , .. � � . � , .. _ �..'� � .. . � � , � \ <br /> t.'r <br />�ry� 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 /> ;�:r <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> i.Lr" <br /> VENTILATION <br /> No. � Kitchen Exhaust � ducted recirculating �i%� cfm <br /> �' No. Bath Exhaust (must be ducted outside) cfm '�' <br /> No. Other Fans: Locations cfm <br /> ` L��': l� �J�' .Zr� S 1`� ��,':i: �'�c: (<<� �-/' /�; � 1z� C.���-�< `rc�, ��'/���°�� <br /> FUEL STORAGE (MUST BE APP�OVED 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%o of Contract Price* or Minimum Fee ($35.00) � <br /> �,�`�•�; x .0125 $ <br /> (contract price) <br /> 2. State Surchar� ** Add the State Building Code Division <br /> Surcharge to each permit. x .0005 $ <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) $ <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, 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 City and the regulations of the Minnesota <br /> �;. <br /> State Building Code, and certifies that all statements made on this application are complete, true <br />`c� and correct. <br /> ,� <br /> � <br /> Applicant's Signature: .� , Date: � .� � �� <br /> Approved By: Date: <br /> :,:�. <br /> � � - . ,'�, {��. j L . �4.` _ . . . _ ... . � . ... y �. . ' �" , . <br /> . - . . `k . . , � . . � - � '� . . <br />