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<br />� ' ; WOOD BURNING EOUIPMENT
<br />� � Wood stove with flue
<br /> Wood combination or add-on
<br />� ' Factory fireplace with flue
<br /> r � Factory Fireplace (s) Freestanding Masonr
<br />�` Wood Stove s y
<br /> � � Franklin, other
<br /> , Brand Name Model No.
<br />�. � Mfgr's Min., Clearances, side , rear
<br /> � °x� ��,� , min. flue dia.
<br />� VENTILATION
<br /> K' . No. Kitchen Exhaust ducted recirculating cfm
<br /> x#t No. Z Bath Exhaust (must be ducted outside) cfm
<br /> t� ~ No. Other Fans: Locations
<br />� .. f al r y�� v�-F cfm
<br />��-"� FLTEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL)
<br /> k9� Installation Removal
<br />°�` Fuel oil: gallons underground inside
<br /> '� LP Gas: outside
<br /> gallons
<br /> Other
<br />�'� Gas opening
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<br />�� PERMIT FEE CALCULATION
<br /> ,
<br />�� 1• 1.25% of Contract Price* or Minimum Fee ($35.00)
<br />�;
<br />�:, —._1Fa LG�c;�.��� x .0125 $
<br /> 7 7. c�
<br />� (contract price) —
<br />��:� 2. State Surchar� ** Add the State Building Code Division
<br />�` Surcharge to each permit. $
<br />��.,;� �-Z��. ��.� x .0005 ,3, i v
<br /> '� or $.50, whichever is greater (contract price)
<br />�,,,..
<br />�n. 3• Posta�e and Handlin� (Only mail-in applications) $
<br />��.; 4. TOTAL PERMIT FEE `��
<br /> (Add lines 1-3 above) $ �U��, ,,
<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pernutted
<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 />��� **
<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 Mechani
<br />� cal 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 />�,
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<br />�. Applicant's Signature: ��L_
<br /> Date: 3//cJ/�'j�
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<br />� - Approved By: -
<br /> Date: 5 �� `l7
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