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<br /> WOOD BURNING EQUIPMENT ,
<br /> Wood stove with flue � t�� .�
<br /> Wood combination or add-on '��.k� ` > �
<br /> ��� , ��;. Pi
<br /> � � � °�'� � .'���� Factory fireplace with flue � � �� � � =i
<br /> �-------
<br /> � � *��� � �-���� Factory Fireplace (s) Freestanding Masonry ���
<br /> '��' � '�`� Wood Stove (s) Franklin, other ;{
<br /> °� ��� £�
<br /> = � � � � Brand Name Model No. �
<br /> � '�'' ry Mfgr's Min., Clearances, side , rear , min. flue dia.
<br /> �-
<br /> f .:
<br /> � ` � VENTILATION
<br /> No. Kitchen Exhaust ducted recirculating cfm �
<br /> No. Bath E�aust (must be ducted outside) cfm
<br /> No. Other Fans: Locations cfm
<br /> `�
<br /> 7
<br /> RI
<br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MA�SHAL) _�
<br /> �
<br /> Installation Removal �
<br /> Fuel oil: gallons underground inside outside
<br /> LP Gas: gallons ;;
<br /> Other Gas opening
<br /> PERMIT FEE CALCULATION
<br /> l. 1.25% of Contract Price* or Minimum Fee ($35.00) Fj,Q0 ,
<br /> . ^i(;�i.�,�-�_, x .0125 $
<br />, ,� (contract price)
<br /> 2. State Surcharge. ** Add the State Building Code Division
<br /> Surcharge to each permit. �,�:�.��,� x .0005 $ � ►��
<br /> or $.50, whichever is greater (contract price)
<br /> 3. Posta�e and Handlin� (Only mail-in applications) :" $ 1.50
<br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ ��1,'��
<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pemutted
<br /> work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the
<br /> - --- �.,. . �:-__ customer for the work do*�e. If any material, equipment, labor, or installation are furnished by the owner,
<br /> ,` ;; ` tenant or any other party the reasonable market 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 /> `'��>y� � " the City may request the submission of a signed copy of the actual contract.
<br /> ek. �
<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 certifie a a tatements mad lication are complete, true
<br /> and correct.
<br /> A licant's Si ture: Date: �--`7 )�f �
<br /> PP �
<br /> Approved By: Date: �� L� �� (
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