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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.
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<br /> VENTILATION
<br />� Y� No. Kitchen Exhaust ducted recirculating cfm
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<br /> No. Bath Exhaust (must be ducted outside) cfm
<br /> No. Other Fans: Locations cfm
<br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL)
<br /> _� Installation �C Removal - m?-io,00�, /- 80do - G'AS 'N�S • ��e
<br /> Fuel oil: gallons underground inside outside
<br /> LP Gas: gallons
<br /> Other �j�/S;R�� ,NC�.J a id ooe Gas opening
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<br />� ' PERMIT FEE CALCULATION
<br />;�_,, "
<br /> }� ' 1. 1.25% of Contract Price" or Minimum Fee ($35.00)
<br /> �� ' � �(QQ,00'o �� x .0125 $
<br />� { (contract price)
<br /> r 2. State Surcharge. *" Add the State Building Code Division
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<br />;e<. = Surcharge to each permit. x .0005 $
<br /> or $.50, whichever is greater (contract price)
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<br /> . : 3. Postage and Handlin� (Only mail-in applications) $ 1.50
<br /> 4. TOTAL PERMIT FEE (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 pernut 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 correct.
<br /> Applicant's Signatur • Date: .0��-��
<br /> Approved By: `�� �"�-�- Date: � -S "��
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