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<br /> �� ��_ ' WOOD BURNING EOUIPMENT �����' �"°"�
<br /> "T� ��k ����'���� Wood stove with flue � �
<br /> L `'�'� :
<br /> �. ,.��s'�� Wood combination or add-on '
<br /> ° Factory fireplace with flue .�
<br />�:_�
<br /> ��' Factory Fireplace (s) Freestanding Masonry
<br /> �xr Wood Stove (s) Franklin, other �,;
<br /> ,��
<br />� Brand Name Model No.
<br />' �:;; > Mfgr's Min., Clearances, side , rear , min. flue dia. F ��
<br />�:`" ' � �;
<br /> ,
<br />°� VENTILATION ��
<br />�� No. � Kitchen Exhaust ✓ ducted recirculating cfm ` r. �{�
<br />�� ,. No. ( Bath Exhaust (must be ducted outside) cfm b' ��
<br /> � ��,:
<br /> � No. Other Fans: Locations cfm ' � ��'`�
<br /> 4 �� �
<br /> r� FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) k'k;
<br />�� ,�, �
<br /> � Installation Removal ,
<br />�� Fuel oil: gallons underground inside outside S
<br /> LP Gas: gallons ° � `
<br />� �, �
<br /> , � Other Gas opening � �>���� �.� a
<br />'� ,`
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<br />� � ��`� � PERMIT FEE CALCULATION � �'
<br /> 4�k� ,� �. �4 a
<br />� .� . : 1. 1.25% of Contract Price* or Minimum Fee ($35.00) �,
<br /> E �'.��5.�v x .0125 $ �
<br />� �
<br />,�� ' , (contract price) ''
<br />` � . 2. State Surcharge. ** Add the State Building Code Division t'
<br />� „ '; Surcharge to each permit. x .0005 $
<br />��fi� r ' or $.50, whichever is greater (contract price) ,�
<br />� -
<br />�,�_ � � �'
<br /> �x� : x , «�
<br />��` ��f, � �J� 3. Postage and Handlin� (Only mail-in applications) $ 1.50 �;���,� �;
<br /> � : 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ;:�� -�� `° ��r -�
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<br />�. �
<br /> _�
<br />�� ' � : * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted i,", r� ,;'
<br /> F �.� � � �`�� work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the =���
<br />� r ,. customer for the work done. If any material, equipment, labor, or installation are fumished by the owner, � '��y
<br />� { ' tenant or any other party the reasonable market value of such items must be added to the estimated cost '4 �#
<br />��x,�* `��'r` or contract price for permit fee purposes. In the event that there is a dispute on the amount of the job cost,
<br /> r ,z� ; '`.
<br /> r { ,.; , ;f the City may request the submission of a signed copy of the actual contract. , *
<br />�•' a ', � , � -� s,
<br />� '' . ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is :�
<br /> � 3<^ �- greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price. �
<br /> r; : �.
<br /> � - The undersigned hereby applies to the Ciry for issuance of a Mechanical Permit, agrees to do ��
<br /> �
<br />� ��`�°A all work in strict accordance with the ordinances of the City and the regulations of the Minnesota �P_y 7 s,k v,
<br /> � ,{� � State Building Code, and certifies that all statements made on this application are complete, true ,�: '
<br />���7�� and correct. -'�� ;�
<br />, � �;�
<br /> ��
<br /> A � ,(�
<br />�� y- Applicant's Signature: �.,.�, `(���., Date: Z - l S� '`�� � -` '
<br /> � , "
<br />���e � 'd S�:.
<br /> ��
<br /> µ°�� Approved By: Date: '���"
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