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<br /> � ��r �.. . . .
<br /> � s� WOOD BURNING EOiTIPMENT �- � r-��� .
<br /> ,
<br /> - Wood stove with flue �`� ,�' �� �r��;�- �-�=� � --� '��-�°�,�-�'
<br /> -�~ Wood combination or add-on -��` � ��'�`�r�"
<br /> � x � .-�`�'��`�,
<br /> � � ����. �.x�� �.
<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. N:,`;
<br /> �
<br /> ; � : VENTILATION .
<br /> , ,.`�'` ` No. Kitchen Exhaust ducted recirculating cfm �
<br /> ����- No. Bath Exhaust (must be ducted outside) cfm °=
<br /> , .�. �. �� �
<br /> No. Other Fans: Locations
<br /> . .
<br /> � �, FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) - �
<br /> ' j��`� Instaliation Removal � .
<br /> F ', , _ Fuel oil: gallons underground inside outside
<br /> �, - � �� LP Gas: gallons �
<br /> Other Gas opening �
<br /> .�
<br /> �Y�. . . . '.. E
<br /> PERMIT F'EE CALCULATION ��
<br /> � 1. 1.25% of Contract Price* or Minimum Fee ($35.00)
<br /> t � � � � �n I_1� ` X .�125 �P / (v'' /�•
<br /> �(contract price) , � _
<br /> � . � 2. State Surchar�e. ** Add the State Building Code Division �I
<br /> �:,:. .
<br /> � ' Surcharge to each permit. x .0005 $ � ��' �;
<br /> �� � or $.50, whichever is greater (contract price) ���
<br /> �
<br /> 3. Posta�e and Handlin� (Only mail-in applicafions) $ 1.50 �
<br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ f� �� '
<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollaz 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 done. If any material, equipment, labor, or installation aze 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. 5
<br /> �r� er 1 000 000 or $.50 - whichever is �
<br /> � ," _ The STATE SURCHARGE is .0005 of the contract pnce und $ , , ,.�
<br /> � _ greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price. � -
<br /> The undersigned hereby applies to the Ciry 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 /> #
<br /> �- Applicant's Signature:`� , Date: ��� �O'L
<br /> - .� ?�� ,� =
<br /> k.�_�.
<br /> �� � , Approved By: Date: -
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