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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 /> VEN1'ILATION
<br /> No. Kitchen Exhaust ducted recirculating cfm
<br /> No. Bath Exhaust (must be ducted outside) cfm
<br /> No. Other Fans: Locations cfm
<br />� FUEL STORAGE (MUST �E APPROVED BY FIRE MARSHAL)
<br /> Installation Removal ��,
<br /> Fuel oil: gallons underground inside outside
<br /> LP Gas: gallons �5
<br />�.� Other Gas opening �
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<br /> PERMIT FE� CALCULATION '�
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<br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) �
<br /> ,�7� �`I C� ,�O x .0125 $ :3(c� 1_3
<br /> (ccr.t:act price;
<br />� 2. State Surcharge. ** Add the State Building Code Division
<br />��, Surcharge to each permit. �, 5�1(: � �`�� x .0005 $ 1 , `f�
<br /> or $.50, whichever is greater (contract price) �
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<br /> 3. Postage and Handlin� (Only mail-in applications) $ 1.50
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<br /> 4. TOTAL PERMIT I=EE (Add lines 1-3 above) $ 3`t• � y
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<br />���. * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted
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<br />-�r` 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 />`t.','1� 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. �
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<br /> ** The S'fATE SURCHARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is
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<br /> greater. For valuations over $1,000,000 call the Department of Inspectional Services for the price.
<br /> The undersigned hereby appli�s to the City for issuance of a Mechanical Permit, agrees to do
<br /> all work in strict accurc!ance 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.
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<br /> Applicant's Signature:�_�'LQ�� (� �C�(����"�=- Date: l%`/����
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<br /> Approved By: Date: '�
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