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<br /> WOOD BURNING EQUIPMENT
<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 c�s U cfm
<br /> .� , �
<br /> No. Bath Exhaust (must be ducted outside) cfm
<br /> No. Other Fans: Locations cfm
<br /> �. �a� �F/'-t �"//IG! S,�S?��� S.
<br /> FUEL STORAGE (MUST BE 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 /> � '� . ���� , .�; x .0125 $ � �� • �.-
<br /> ( ontract price)
<br /> 2. State Surchar�e. "" Add the State Building Code Division
<br /> ., ,',? p,.,.,
<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) $ ? r. ' .
<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 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 certifies that all statements made on this application are complete, true
<br /> and conect.
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<br /> Applicant's Signature: ; .,�.��,,,�, ���ti..K���,-- Date: `.� � � - �
<br /> Approved By: Date: U',J �� L
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