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<br /> �,� .: WOOD BURNING EOUIPMENT , : - .
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<br /> Wood stove with flue � � ���
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<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 /> 1 � :;, J FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) �s�- >: ���# R
<br /> _>..YT Installation Removal ' ,�`
<br /> Fuel oil: gallons underground inside outside
<br /> �
<br /> � A LP Gas: gallons ''
<br /> ' '' Other Gas opening
<br /> PERMIT FEE CALCULATION
<br /> � 1. 1.25% of Contract Price* or Minimum Fee ($35.00)
<br /> /5��3c: �' x .0125 $ / i� � .$ ,
<br /> .n
<br /> (contract price)
<br /> � 2. State Surcharge. ** Add the State Building Code Division ;� 2
<br /> `, �';: Surcharge to each permit. x .0005 $ �
<br /> ��:; or $.50, whichever is greater (contracc price)
<br /> ; .� �,�
<br /> 3. Posta�e and Handling (Only mail-in applications) $ 1.50 -
<br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ :�C-�.z '` ,�;: , ;;
<br />:�,.:
<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 wor'.�c dor.e. If any material, equipment, la`uor, or installati.;n aza fumishe�i by t1�e 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, r�
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<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 /> .a: 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
<br /> and correct.
<br /> �, : � Applicant's Signature: � Date:
<br />�.
<br /> Approved By: Date:
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