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<br />�.�; � WOOD BURNING EOUIPMENT ��
<br /> Wood stove with flue
<br /> Wood combination or add-on r
<br /> { . %`: .. �} Factory fireplace with flue
<br /> A ' ' '�' Factory Fireplace (s) Freestanding Masonry
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<br /> - Wood Stove (s) Franklin, other
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<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 /> A;' 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) �
<br /> Installation Removal '-'
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<br /> Fuel oil: gallons underground inside outside ��
<br /> LP Gas: - gallons '
<br /> ' Other t Gas opening �� �
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<br /> k �-� ��j C s s L�� -7-�> >%;���, r. -� 5 �� f,,./��t , ,.
<br />�` PERMIT FEE CALCULATION
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<br />;;;: 1. 1.25% of Contract Price* or Minimum Fee ($35.00)
<br />"�� S'S�_ �-- x .0125 $
<br /> (contract price)
<br />� #�, � '� 2. State Surchar� ** Add the State Building Code Division
<br /> Surcharge to each permit. x .0005 $ ��
<br /> '�` or $.50, whichever is greater (contract price)
<br /> ,45, ..
<br /> 3. Postage and Handling (Only mail-in applications) $ 1.50 '`
<br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ `?t
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<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the permitted ,i
<br /> work including materials, labor, profi[, 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 aze fumished 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 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 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 /> 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: 'u� � � Date: lv o c;
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<br /> Approved By: Date: �
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