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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 �r
<br /> Brand Name Model No. ;�'
<br /> , ': Mfgr's Min., Clearances, side , rear , min. flue dia.
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<br /> � �' VENTILATION
<br /> No. Kitchen Exhaust ducted recirculating cfm
<br /> No. Bath Exhaust (must be ducted outside) cfm
<br /> No. Other Fans: Locations cfm ��
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<br /> ' FUEL STORAGE MUST BE APP VED BY FIRE MARSHAL �
<br /> ( . RO )
<br /> Installation Removal ;
<br /> Fuel oil: gallons underground inside outside I
<br /> LP Gas: gallons ;
<br /> Other Gas opening �
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<br /> PERMIT FEE CALCULATION j
<br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.001
<br /> �/c,'-�.�jU x .0125 $ �C.,�,� ', -`�- c:c;
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<br /> (contract price)
<br /> 2. State Surchar�e. ** Add the State Building Code Division I
<br /> Surcharge to each permit. ���`�-�� x .0005 $ /, ���
<br /> or $.50, whichever is greater (contract price)
<br /> 3. Posta�e and Handling (Only mail-in applications) $ 1.50 "�
<br /> "" 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ _ ��, �O -� J-S� j
<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted !
<br /> work including materials, labor, profit, and other fized 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,
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<br /> tcaar.t o:a;.y othc: p�y the reasonable �arket value of such ite.•ns mnsi �e 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 /> j the City may request the submission of a signed copy of the actual contract. I
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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 i
<br /> State Building Code, and certifies that all statements made on this application are complete, true '
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<br /> and correct. ,
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<br /> ` � A licant's Si nature: ��2�� ( � Date: `/- /t'vL%
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<br /> Approved By: Date:
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