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<br />���`�� WOOD BURNING EQUIPMENT � ``
<br />���.��; Wood stove with flue . �'��#
<br /> " ' Wood combination or add-on ��
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<br />�t=� Factory fireplace with flue �
<br />� " ' '' Factory Fireplace (s) Freestanding Masonry ; ;
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<br />� Wood Stove (s) Franklin, o er *'
<br /> A Brand Name Model No. �:
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<br /> ,f�� ` Mfgr's Min., Clearances, side , rear , min. flue dia. ` , �
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<br /> � � �� � VENTILATION �� ��
<br />�'� No. Kitchen Exhaust ducted recirculating cfm "x
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<br /> �t � No. Bath Exhaust must be ducted outside cfm ,��
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<br /> °� ��'_ No. Other Fans: Locations cfm ��
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<br />�,-„� r FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) ��
<br /> *�`�-G��:��� Installation Removal �;�
<br />����� � Fuel oil: gallons underground inside outside # �
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<br /> LP Gas: gallons �'
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<br /> -� . Other Gas opening
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<br /> ��,��;��.��� PERMIT FEE CALCULATION � � 7a��. � ��� ��`
<br /> ��,�. 1. 1.25% of Contract Price* or Minimurh Fee ($35.00) $ �3. �S ��
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<br /> �` k� '=f'�"' 2. State Surchar�e. ** Add the State Building Code Division $ 3 3� �z�
<br />���� Surcharge to each permit. .----- �r�'.
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<br />=9 f= 3. Posta�e and Handline (Only mail-in applications) $ 1.50 �7,/v ��
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<br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �
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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 '� ����'
<br /> N�� � customer for the work done. If any material, equipment, labor,or installation are furnished by the owner, g ;�
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<br /> tenant or any other party the reasonable market value of such items must be added to the estimated cost ' � ,A�
<br /> �" � ��t' 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 /> ��r �'` the City may request the submission of a signed copy of the actual contract. ��
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<br /> r`� }`� k� ' ** 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. ° '� �
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<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 o f t he City an d t he regu lations o f t he Minneso ta Y�
<br />� �" �' State Building Code, and certifies that all statements made on this application are complete, true � � -�'
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<br />� and correct. � � �.�f M
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<br /> , .I^ ' e. /� �/-�=='-�2��: Date: ' - � � j#��
<br /> {.'. ¢ Applicant s Signatur �
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