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<br /> WOOD BURNING EOUIPMENT " -
<br /> Wood stove with flue �
<br /> Wood combination or add-on b'
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<br /> Factory fireplace with flue ''�
<br /> � Factory Fireplace (s) Freestanding Masonry
<br /> Wood Stove (s} Franklin, other >:
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<br /> � , Brand Name Model No. �'
<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 "��c,
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<br /> �'+LTEI� STL'RAGE (R1US�' L'E AFPROVED Ei' i�2E M^ 'S�IAL)
<br /> Installation Removal
<br /> Fuel oil: gallons underground inside outside {�
<br /> LP Gas: gallons ''
<br /> �.
<br /> Other Gas opening �:�
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<br /> PERMIT FEE CALCULATION � ��� � ���
<br /> - 1. 1.25% of Contract Price* or Minimum F�e ($35.00)
<br /> �G�- x .0125 $ �Cj. �C�
<br /> (contract price) '��
<br /> 2. State Surchar�e. ** Add the State Building Code Division "'`
<br /> Surcharge to each permit. x .0005 $ , ��J
<br /> or $.50, whichever is greater (contract price) ='
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<br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50
<br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ � ��� �
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<br /> � ��',: * CONTRACT PRICE or JOB COST means the actual or estunated dollar amount chazged for the pemutted �
<br /> : work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the
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<br /> customer for the work done. If any material, equipment, labor, or installation are fumished by the owner,
<br /> tenant or any other party the reasonable mazket value of such items must be added to the estimated cost
<br /> or contract price for pemut fee purposes. In the event that fnere is a�iispute on the amount oi t�e job cost,
<br /> the Ciry 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
<br /> and conect. �
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<br /> Applicant's SiQnature: p�.�r 4 �JL�.V'' Date: - G'¢'
<br /> Approved By: Date: � ' — 0`�
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