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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 />, ,'; • 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 /> No. Kitchen Exhaust ducted recirculating cfm
<br />�' No. Bath Exhaust (must be ducted outside) cfm
<br />�" � '�' �- ' � No. Other Fans: Locations cfm
<br /> �u�;I, S�10RA' GE (1VIUST B� APPROi%E17 BY FIlZE MAI2SrIEiL)
<br /> Installation Removal
<br />, .;, , _ Fuel oil: gallons underground inside outside rs
<br />�` f `� LP Gas: gallons `
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<br />� Other Gas opening `
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<br />`���' PERNIIT FEE CALCULATION
<br />��,
<br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) ��o
<br /> :�K.00" x .0125 $ `� Z,'
<br />�g (contract price)
<br /> � .. �; 2. State Surchar�e. ** Add the State Building Code Division '7 �
<br /> mY�,.
<br />�.., ,i�, Surcharge to each permit. x .0005 $ � .,
<br />� ��° '�� or $.50, whichever is greater (concracc price)
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<br /> 3. Postage and Handling (Only mail-in applications) $ 1.50
<br />''� 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ Lf .f-� ?�
<br />�,
<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 fumished by the owner,
<br /> a > ,.;' � .�� � tenant or any other party the reasonable mazket value of such items must be added to the estimated cost
<br />� ,f �y;r �.;;.�;�, or contract price for pemut fee purposes. In the event that there is a dispute on the amount of the job cost,
<br /> �4 ;�°�; Y,a, the City may request the submission of a signed copy of the actual contract.
<br /> �-
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<br /> 4 M� ' ** The STATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is '
<br /> �r greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price.
<br /> . .��',
<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 /> e; � State Building Code, and certifies that all statements made on this application are complete, true
<br />�:��
<br />�%; and conect.
<br />- ----' -Z�--� �
<br /> Applicant's Signature: � Date: q
<br /> Approved By: Date: l(� - ?�O� `�y •
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