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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. �`'
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<br />�� VENTILATION ' ,,.w�
<br />�A!_
<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)
<br /> Installation Removal
<br />��� Fuel oil: gallons underground inside outside f
<br /> LP Gas: gallons
<br /> � Other Gas opening
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<br /> PERMIT FEE CALCULATION
<br /> 4�' 1. 1.25% of Contract Price* or Minimum Fee ($35.00)
<br /> �:` 3
<br /> f��� � x .o�25 � �a ° y
<br />�°'' (contract price) �.r�
<br />>�� 2. State Surcharge. "" Add the State Buildin Code Division a�
<br /> 4 ' Surcharge to each permit. /���o� x .0005 $ —
<br /> or $.50, whichever is greater (contract price)
<br />,:` 3. Posta�e and Handling (Only mail-in applications) $ 1.50 y�
<br />,�' 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �r;=
<br /> � �;,:
<br /> � * CONTRACT PRICE or JOB COST means the actual or estimated dollar 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 fumished by the owner,
<br /> tenant o:any cther pa�-ty ti�e reasonable market value of such items must be added to the estimated cost
<br /> or contract price for pemut 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. '°
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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 '
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<br /> and conect.
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<br />� Applicant's Signature. � /'j/S�-� Date:�' �s- (�3
<br /> Approved By: Date: >�_<
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