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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 /> Mfgr's Min., Clearances, side , rear , min. flue dia.
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<br /> VENTILATION
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<br /> �`, No. Kitchen Exhaust ducted recirculating cfm
<br /> No. Bath Exhaust (must be ducted outside) cfm
<br /> No. Other Fans: Locations cfm -�+
<br /> FUEL STQRAGE (MUST BE APPROVED BY FIRE MARSHAL)
<br />" Installation Removal
<br /> . Fuel oiL• gallons underground inside outside
<br /> LP Gas: gallons i
<br /> � � Other Gas opening
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<br /> PERMIT FEE CALCULATION ,�
<br /> �� 1. 1.25% of Contract Price* or Minimum Fee ($35.00)
<br /> � 3��.t� x .0125 $ 4 Z. 63 :��
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<br /> (contract pricej . "a
<br /> � 2. State Surchar,�e. ** Add the State Building Code Division �
<br /> Surcharge to each permit. � '34 L v x .0005 $ � . � � }��
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<br /> or $.50, whichever is greater (concracc price)
<br />�ry�, �s; 3. Posta�e and Handling (Only mail-in applicafions) $ 1.50
<br />,_F, , ' 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ 4 5,, g 4
<br />, * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount chazged for the permitted
<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 /> tenant or any other party the reasonable mazket value of such items must be added to the estimated cost
<br /> 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.
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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 �j
<br /> and correct. ``
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<br /> Applicant's Signature: � Date: 7� �3 -9 q�
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<br /> Approved By: Date: �- ��- � �f
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