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<br />�,�` WOOD BURNING EOUIPMENT
<br />�:
<br />��� Wood stove with flue
<br />��� Wood combination or add-on
<br />$� - Factory fireplace with flue
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<br />�.�. r� r ,� �: • Factory Fireplace (s) Freestanding Masonry
<br /> �� `� Wood Stove (s) Franklin, other
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<br />� ����F �,` Brand Name j-�Ea�: iN-- �>�-C:.� Model No. /�� C�Z nti,l�
<br />�,� �,�r: Mfgr's Min., Clearances, side , rear , min. flue dia. �
<br /> �, C:•F>; ��� �2C t' c r�CL �-4 i�' SC-�Z" \ :,:"
<br /> ��� VENTILATION _
<br />���.�-`' No. Kitchen Exhaust ducted recirculating cfm
<br />��� �' No. Bath Exhaust (must be ducted outside) cfm
<br />���
<br /> � ' ' ` �� No. Other Fans: Locations cfm �'
<br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) ��-��
<br /> - Installation Removal
<br /> r' � , Fuel oil: gallons underground inside outside ' �
<br />" " LP Gas: gallons � �
<br /> i � :- x,�'��.��� ;s
<br />� _, , Other Gas opening
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<br />��` PERMIT FEE CALCULATION �
<br /> s 1. 1.25% of Contract Price* or Minimum Fee ($35.00) `�
<br />� _���. �.c�; x .0125 $ �1 1 �- �"
<br /> �- (contract price)
<br /> f�='� �" 2. State Surcharge. ** Add the State Building Code Division
<br />� `�la � ��i �� /c'.�'� � . � � i
<br />�, Surcharge to each permit. _ � f �- - x .0005 $ 1'.
<br />�''�� ;�F or $.50, whichever is greater (contract price) �
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<br />��,� �,. 3. Posta�e and Handling (Only mail-in applications) $ 1.50
<br />� �' `� 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �-i 2 • G >
<br />�� �
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<br />� � ;
<br />� ,�' * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted `l� ^
<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, ,�
<br />��` �" , ', � �y' 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, �.�'
<br />�� the City may request the submission of a signed copy of the actual contract. `� �
<br /> �' � a �
<br /> ��
<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 />`�" ':; �
<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 ;;� y�
<br /> �`���';.` State Building Code, and certifies that all statements made on this application are complete, true +.�;..
<br /> � � :.
<br /> � and conect.
<br /> � �� r � `3` Applicant's Signature: �w --- Date: ti � �� ����'
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<br />.� ���� Approved By: Date:
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