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<br /> WOOD BURNING EOUIPn7ENT ,
<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.
<br /> VENTILATION
<br /> No. Kitchen Exhaust ducted recirculating cfm
<br /> No. Bath Exhaust (must be ducted outside) cfm
<br /> No. Other Fans: Locations cfm
<br /> FUEL STOFcAGE (MUST �E APPROVED BY FIRE MARSHAL)
<br /> Installation Removal
<br /> Fuel oil: gallons underground inside outside
<br /> LP Gas: gallons
<br /> Other � Gas opening
<br /> PERMIT FEE CALCULATION
<br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00)
<br /> � U�-Y,,, ._ X .oi2s $ :3�5 c�'
<br /> (contract price)
<br /> 2. State Surcharge. ** Add the State Building Code Division
<br /> Surcharge to each permit. �yC��,, — x .0005 $ � ��
<br /> or $.50, which�ver is greater (contract price)
<br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50
<br /> 4. TOTAL PERMIT PEE (Add lines 1-3 above) $ ��� ��-'
<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 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 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 /> the City may request the submission of a signed copy of the actual contract.
<br /> ** The S'CATE SURCHARGE is .0005 of the contrac[ 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 appl i�� to the City for issuance of a Mechanical Permit, agrees to do
<br /> all work in strict accurc!ance 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 correct.
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<br /> Applicant's Signature: , ; �t,�'�. ��l�C 1 � ���� Date: �`a�`1
<br /> Approved By: Date:
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