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<br />'; � ` WOOD BURNING EOUIPMENT
<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 be ducted outside) cfm "`�
<br />; .,��_; No. Other Fans: Locations cfm �
<br />� �� ,� .���� FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) 4
<br /> ;�'�� -� � �n� Installation Removal y ��
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<br /> Fuel oil: gallons underground inside outside 1� :
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<br /> LP Gas: gallons ,'
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<br />.ry,� Other Gas opening
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<br />�'y PERMIT FEE CALCULATION
<br /> 1. 1.25% of Contract Price* or Minimum Fee (�3�,001 �
<br /> r � � _ ,�-��Z x .0125 $ �� �,�
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<br /> -� (contract price) '
<br />°{� 2. State Surcharge. ** Add the State Bui ding Code,�?ivision '.� �
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<br /> H�-.•:�- Surcharge to each permit. �C�`T .�L�L1 x .0005 $ ► Cj ..y:.��. `�
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<br />�,� ���Ar or $.50, whichever is greater (concract price) :;
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<br /> �� 3. Posta�e and Handling (Only mail-in applications) $ �,
<br /> �: 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ c ` "'
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<br />�' * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted `
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<br /> ��`� work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the
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<br />� � cnstom�r for:he work dene. If any material, equipment, labor, or installation aze 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 rice for emut fee u ses. In the event that there is a dis ute on the amount of the ob 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 Ciry for issuance of a Mechanical Permit, agrees to do
<br />�� all wark 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 ��v,� �
<br />� �,,� _ .:`� and correct. "`�k` °k
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<br /> .� "- Applicant's Signature: � Date: �
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<br /> � �; Approved By: Date: ,
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