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<br />'�: WOOD BURNING EQUIPMENT � rr
<br /> Wood stove with flue p�
<br /> Wood combination or add-on � y�;
<br /> Factory fireplace with flue
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<br /> Factory Fireplace (s) Freestanding Masonry
<br /> Wood Stove (s) Franklin, other �"
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<br /> Brand Name � Model No. ��
<br /> �: Mfgr's Min., Clearances, side , rear , min. flue dia. s
<br /> � ��� �� ��°� VENTILATION ���
<br /> _ No. Kitchen Exhaust ducted zecirculating cfm �.
<br /> , 4� � No. Bath Exhaust (must be ducted outside) cfm � ; P:�
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<br /> ''�' No. Other Fans: Locations cfm � �";
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<br /> � FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) �` � x "'�
<br /> . .:�4' ���
<br /> Installation Removal � �
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<br /> Fuel oil: gallons underground inside outside �
<br /> LP Gas: gallons �
<br /> � ; Other Gas opening �
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<br /> A ' PERMIT FEE CALCULATION � �
<br /> ,�.��+ 1. 1.25% of Contract Price* or Minimum Fee ($35.00) �
<br /> � � ��2, ��5: �d X .oi2s $ '�7 T79- /� �
<br /> (contract price) '�
<br /> 2. State Surchar� ** Add the State Building Code Division
<br /> Surcharge to each permit. Z ` �. G� x .0005 $ �j, /� �
<br /> � '-�'� or $.50, whichever is greater ontract price) �
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<br /> 3. Postage and Handling (Only mail-in applications) $ 1.50 ��
<br />;�T 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �i�, � -,,� ���
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<br /> ✓ F' * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted u, r�
<br /> �, � 5�,` 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 1� '
<br /> or contract price for permit fee purposes. In the event that there is a dispute on the amount of the job cost, � '�
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<br />_ _ � the City may request the submission of a signed copy of the actual contract.
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<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 /> State Building Code, and certifies that all statements made on this application are complete, true
<br /> and correct.
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<br /> Applicant's Signature: /i`"/��,,��,� -7 ��%���Date: l� �I' � � .,, .�:
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<br /> Approved By: Date: �
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