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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 rnp,�;r-s i;L Model No. ��-},-1}Z `
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<br /> Mfgr's Min., Clearances, side , rear , min. flue dia.
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<br /> . VENTILATION �;
<br /> r � No. Kitchen Exhaust ducted recirculating cfm �
<br /> ,. : : No. Bath Exhaust (must be ducted outside) cfm '�
<br /> _ No. Other Fans: Locations cfm �
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<br /> �� ��; ��� FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) �
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<br /> Installation Removal
<br />� Fuel oil: gallons underground inside outside �
<br /> LP Gas: gallons
<br /> �� Other Gas opening
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<br /> r �. '';" PERMIT FEE CALCULATION
<br /> � '�� , 1. 1.25% of Contract Price* or Minimum Fee ($35.00)
<br /> t�Yx'>°`� x .0125 $ �
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<br />�>,; (contract price)
<br /> 2. State Surchar� "" Add the State Building Code Division
<br /> Surcharge to each permit. x .0005 $ '`
<br />,�t��, , , or $.50, whichever is greater (contract price) -
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<br /> 3. Posta�e and Handling (Only mail-in applications) $ 1.50
<br /> ,�� ,� 4. TOTAL PERMIT FEE (Add lines 1-3 above) $
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<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged 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 /> z � tenant or any other party the reasonable market value of such items must be added to the estimated cost
<br /> W or contract price for pemut 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 />� x ` ** 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 /> r State Building Code, and certifies that all statements made on this application are complete, true
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<br /> z .r and correct.
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<br /> ' Applicant's Signature: Date: � 7-y�J
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<br />�� -, Approved By: Date: --
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