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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.
<br /> VENTILATION
<br /> No. Kitchen Exhaust ducted recirculating cfm
<br /> F ''E No. Bath Exhaust (must be ducted outside) cfm
<br /> �'4 No. Other Fans: Locations cfm
<br /> ��
<br />, �:�
<br /> ;i
<br /> FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL)
<br /> Installation Removal
<br />; Fuel oil: gallons underground inside outside
<br /> LP Gas: gallons
<br /> Other Gas opening
<br /> PERMIT FEE CALCULATION
<br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) • a,Sr
<br /> ��-SG o � x .0125 $ ,3 1 `"
<br /> f (co tract price)
<br /> 2. State Surcharge. ** Add the State Building Code Division �. S`
<br />' Surcharge to each permit. x .0005 $ / —"
<br /> or $.50, whichever is greater (contract price)
<br />� " 3. Postage and Handlin� (Only mail-in applications) $ 1.50
<br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �_� 6�
<br />� * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount chazged 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 />�
<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 /> gre�r. For valuations over $1,000,000 call the Department of Inspectional Services for the price.
<br /> The undersigr�''d 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 Signature: �--wU� �--���;�,� Date: � � �
<br /> �
<br /> Approved By: Date:
<br /> ; : S �
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