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<br /> WOOD BURNING EOUIPMENT � �
<br /> '� :
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<br /> ��. Wood stove with flue �"
<br /> ,� � � `�� Wood combination or add-on �� � i ;�
<br /> >*�� ' � Factory fireplace with flue �' -
<br /> ` , �� , ,.•�' Factory Fireplace (s) Freestanding Masonry
<br />��� u�` ` Wood Stove (s) Franklin, other z
<br /> � ` � Brand Name Model No.
<br />�, �'� � ��, Mfgr's Min., Clearances, side , rear , min. flue dia. �
<br /> 4,.� W}..� .
<br /> V.
<br />� ��' �� VENTILATION �
<br />�''` No. Kitchen Exhaust ducted recirculating cfm �;�zr .
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<br /> �" � No. Bath Exhaust (must be ducted outside) cfm ' �
<br />���: _ � �
<br />%�*� No. Other Fans: Locations cfm `��� � -"
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<br /> � � ��'
<br />� `� � E � � FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) �
<br /> �°�`T ,;' Installation Removal �
<br /> ;� ' �� Fuel oil: gallons underground inside outside i
<br /> � , ,� �� =
<br /> ,- �
<br /> kw� LP Gas: gallons k
<br /> F�`� � ' � Gas opening �
<br />� ,� ��_., ;� Other �
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<br /> � PERMIT FEE CALCULATION � �:i ��
<br />� ; 1. 1.25% of Contract Price* or Minimum Fee ($35.00) �' ����
<br />�
<br />�� = � �Cj, G� � �
<br />��1 . x .0125 $ "�
<br />�,z ti° (contract price) ��
<br /> � ' � 2. State Surchar� ** Add the State Building Code Division {
<br /> �� � F '^ Surcharge to each permit. x .0005 $ �`
<br />��Y or $.50, whichever is greater (contract price) �'
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<br />� 3. Postage and Handling (Only mail-in applications) $ 1.50 q 'F-�
<br /> �
<br />�� 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �}�
<br />�,�� �::. *�
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<br /> ' p' * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pemutted "
<br />��`� . '�` ' work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the ��.i
<br /> ,. + > - customer for the work done. If any material, equipment, labor, or installation are furnished by the owner, � �
<br /> ,-« ; ���:: �€
<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 pemut fee purposes. In the event that there is a dispute on the amount of the job cost, L�
<br />"`\ the City may request the submission of a signed copy of the actual contract. ��
<br />�3�,z.;����� � � �Q
<br />$�� The STATE SURCHARGE is .0005 of the contract rice under $1,000,000 or $.50 - whichever is �
<br /> **
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<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 /> } x# % ` = 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: /-�� Date: � ~' � ` '� `l .�:
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<br />� Approved By: Date:
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