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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 /> �.o ;. ;- 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. a Bath Exhaust (must be ducted outside) cfm �
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<br /> � No. Other Fans: Locations cfm �
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<br /> - FUEL STORAGE (MUST BE APPROVED BY FIRE MARSHAL) °'s
<br /> Installation Removal �
<br /> Fuel oil: gallons underground inside outside �
<br /> �
<br /> LP Gas: gallons �
<br /> Other Gas opening �
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<br /> P�RMIT FEE CALCULATION �`
<br /> ��
<br /> 1. 1.25%o of Contract Price* or Minimum Fee ($35.00) '�
<br /> ,� 0�0 X .ol2s $ a�2�D o -
<br /> (contract price)
<br /> 2. State Surcharge. ** Add the State Building Code Division p
<br /> Surcharge to each permit. x .0005 $ l. ��
<br /> or $.50, whichever is greater (contract price)
<br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50
<br /> 4. TOTAL PEIZMIT FEE (Add lines 1-3 above) $ 0?3.� .��
<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 ro the
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<br /> customer for[he work done. If any material, equipment, labor, or installation are furnished by the owner,
<br /> tenant or any other party the reasonable mu-ket value of such items mus[ 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 SURCIIARGE is .0005 of the contract price under $1,000,000 or $.50 - whichever is
<br />�• greater. For valuations over $1,000,000 call the DeparUnent of Inspectional Services for the price.
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<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
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<br />-� -, and correct.
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<br /> �_ Applicant's Signature: Date: /d-,�/� /�
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<br />�.'.. Approved By: � Date: gy/���
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