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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 /> a,
<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 x''
<br /> IY y
<br /> �3.,'.
<br /> " FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) �
<br /> i� Installation Removal
<br /> ,`
<br /> Fuel oil: gallons underground inside outside
<br /> a$�.
<br />��� LP Gas: gallons
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<br />�` Other Gas opening ;�t
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<br />"` PERMIT FEE CALCULATION
<br /> � 1. 1.25% of Contract Price* or Minimum Fee ($35.00) ��'
<br />�r:���� .� q��<:� . �:;L, x .0125 $
<br /> (contract price)
<br /> w'� 2. State Surchar� ** Add the State Building Code Division �
<br />��� Surcharge to each permit. x .0005 $ ='
<br />��' or $.50, whichever is greater (contract price) �
<br />;;�
<br />�'� 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 '�
<br />� �,.
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<br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �
<br />, ��
<br /> �
<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount chazged for the pernutted
<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 furnished by the owner, `�F"�
<br /> tenant or any other party the reasonable market value of such items must be added to the estimated cost ,,, �_
<br />�a;; or contract price for permit 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. �.};
<br />�
<br />�, �x:;M,. x; : ; '
<br /> ;. ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is ,
<br />;x-� 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 />�.�y all work in strict accordance with the ordinances of the City and the regulations of the Minnesota
<br />�F��� State Building Code, and certifies that all statements made on this application are complete, true
<br />,` � '
<br /> and conect.
<br /> ,.
<br /> Applicant's Signature: i���I ���G`� � Date: � �� ?9
<br /> �_� Approved By: Date: �'�� ��
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