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<br /> � �� `` Wood stove with flue r�-`
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<br /> ` . ., Wood combination or add-on F ' , �-� ��
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<br /> � E � Factory fireplace with flue ���., ` � ;� , �
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<br /> �` � '` � Wood Stove (s) Franklin, other � f.�� ;
<br /> Brand Name Model No. ' �'`��`'
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<br />� '; '� Mfgr's Min., Clearances, side , rear , min. flue dia. ��-'�� '` �
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<br />� 1'�r VENTILATION �.1 �`4�
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<br />� `;k'�r No. Kitchen Exhaust ducted recirculating cfm ..
<br /> No. Bath E�aust (must be ducted outside) cfm ' '
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<br />�� �� .� No. Other Fans: Locations cfm Y� � 5� ' x��
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<br /> ',�` � �� FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) ��� z t '
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<br />� � � '� Installation Removal �� � �
<br />�` " ''�` Fuel oil: gallons underground inside outside
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<br />�,� �`{=��� . LP Gas: gallons `�
<br />� � `: ' Other Gas opening �a
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<br /> �,' �� `� ��� PERMIT FEE CALCULATION � �' �
<br /> �� 1. 1.25% of Contract Price* or Minimum Fee ($35.00) �'f
<br /> �� ?�c7 x .0125 $ �.SL� �k-: .��
<br />�3^� � ,
<br />�`x (contract price) ' , ��
<br /> ��, _. � 2. State Surchar�e. ** Add the State Building Code Division , j,� � ��
<br />� '� i.5U ��` �'
<br /> � Surcharge to each permit. x .0005 $ ;_ �,4
<br />�°� `,�� �: or $.50, whichever is greater (contract price) �'`>
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<br />�c„ ,x 7
<br /> 3. Posta�e and Handlin� (Only mail-in applications) f $ 1.50 �°� � ��
<br />���' 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �}0.'SC� �; F,� ��
<br /> � :�
<br />�;'�_ * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted *.�
<br /> � ;�° .�€:: work including materials; labor, profit, a�d 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 /> `'� �� �- ��' �,r� tenant or any other party the reasonable market value of such items must be added to the estimated cost ' � .'
<br /> � ;
<br /> ��,�4����� y`�'� �`,;; or contract price for permit fee purposes. In the event that there is adispute on the amount of the job cost, �,,;: ; M�'
<br />�` ^ `°F�` ` ��` the City may request the submission of a signed copy of the actual contract. ;��v;,� ��?
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<br /> � �� 'r ;+`� �* 4'
<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 /> � �
<br /> � � ` ° all work in strict accordance with the ordinances of the City and the regulations of the Minnesota ;��
<br /> � :�:'�.�•' ;
<br /> r_z,� ` State Building Code, and certifies that all statements made on this application are complete, true ,,
<br /> '' ` and correct. 'f
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<br />� �:A Applicant's Signature: Date: �k �
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<br />�°. Approved By: Date:
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