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<br /> WOOD BURNING EQUIPMENT k, �_�, :
<br /> Wood stove with flue
<br /> Wood combination or add-on
<br /> Factory fireplace with flue
<br /> , Factory Fireplace (s) Freestanding Masonry
<br /> s Wood Stove (s) Franklin, other
<br /> , _
<br /> � `��` Brand Name Model No.
<br /> 5 � �:: Mfgr's Min., Clearances, sid� , rear , min. flue dia.
<br />� � ;� Total
<br /> 3 ;' .�' VENTILATION
<br /> No. Kitchen Exhaust ducted recirculating cfm �'
<br />�� ` No. Z Bath Exhaust (must be ducted outside) cfm
<br />� �, No. _� Other Fa*is: Locations cfm
<br /> �., �'�V�� Total �
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<br />� FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) �''�
<br />� Aq Installation Removal
<br />€� � � �� ,��
<br /> Fuel oil: gallons underground inside outside
<br />�� LP Gas: gallons
<br />� Other Gas opening �
<br /> �
<br />� , . �I ;
<br />� . PERMIT FEE CALCULATION
<br />� 1. 1.25% of Contract Price* or Minimum Fee ($35.00)
<br />� `�� 50� - � x 1.25 $ Jr �,. � ��-
<br />� `` f(conuact price)
<br />� : 2. State Surchar�e. ** Add the State Building Code Division
<br /> Surcharge to each permit. x .0005 $ � � �'�
<br /> (contract price) �
<br /> � �.� 3. Postage and Handlin� (Only mail-in applications) $ 1.50 �
<br />�4�'� 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ D � � �'
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<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount chazged for the permitted
<br /> m, ., �=�' work including materials, Iaoor, profit, and other ixed costs. It is the amount t� be �huged to th�
<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 correct. � 3 9 3:5�
<br /> Applicant's Signature: , 1 � C �Ck�ll,�'I� Date: � — I J—�i�
<br />� Approved By: � Date: 1 ( �
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