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<br /> ' �' ;� WOOD BURNING EOUIPMENT , . : ,-' ..
<br /> ,� Wood stove with flue
<br />" '' , Wood combination or add-on
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<br /> �--,' Factory fireplace with flue �:
<br />� .-� .' � Factory Fireplace (s) Freestanding Masonry `
<br /> �>�t' Wood Stove (s) Franklin, other
<br /> R-r.
<br /> � Brand Name Model No.
<br />'��� Mfgr's Min., Clearances, side , rear , min. flue dia.
<br /> k,,;,� VENTILATION � .
<br />� � � No. Kitchen Exhaust ducted recirculating cfm
<br /> *7.'
<br /> � ,;;'; No. Bath Exhaust (must be ducted outside) cfm
<br />_ �� , '' No. Other Fans: Locations cfm
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<br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL)
<br /> `�� � '' Installation Removal
<br />' ~ Fuel oil: gallons underground inside outside
<br /> , LP Gas: gallons >
<br /> w ��� Other Gas opening '
<br /> '� : • �
<br /> �-` � PERMIT FEE CALCULATION
<br /> k'° 1. 1.25% of Contract Price* or Minimum Fee ($35.00)
<br />�=� � ;� �� � x .0125 $ �'��� -_��,
<br /> (contract price)
<br /> k 2. State Surchar�e. ** Add the State Building Code Division f`
<br /> ' � Surcharge to each permit. � - x .0005 $ �`���� ���
<br /> �, � <' or $.50, whichever is greater �(contract price)
<br /> �
<br /> `� = 3. Posta�e and Handling (Only mail-in applications) $ 1.50 `'
<br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ .?i--j _ l �
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<br /> ' * CONTRACT PRICE or JOB COST means the actual or estunated dollar amount charged for the pemutted �
<br /> f�' . work including materials, labor, profit, and other fixed costs. It is the amount to be charged to the
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<br /> �' `' customer for the work done. If any material, equipment, labor, or installation are fumished by the owner,
<br />� �,,, ' tenant or any other party the reasonable mazket value of such items must be added to the estimated cost -
<br />�,
<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 Ciry may request the submission of a signed copy of the actual contract.
<br /> M -� ** 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 /> � t�:�' 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 />_ : ::, .�.
<br /> and conect.
<br /> � � �S--�' Date: �J� ��- �;",�
<br /> Applicant's Signature: �__, '�.�,��. ��
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<br /> ,:��. Approved By: Date: �
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