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<br /> � � t � � _� �
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<br /> $.
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<br /> * $15.00 each unit �fi � �
<br /> WOOD BIIRNING EQIIIPMENT `� , '
<br /> Wood stove with f lue �y ����` �
<br /> � : ��.
<br /> Wood combination or add-on unit }�r� ' ;,�
<br /> Factory fire�lace with flue � �p� �� �" �
<br /> Factor Fireplace (s) freestanding Masonry �' ���`�
<br /> Wood Stove (s ) franklin, other
<br /> Brand Name Mode 1 No. '
<br /> �:
<br /> Mfgr' s Min. , Clearances, side , rear , min. flue dia. \�
<br /> Total
<br /> ******************************************************************************** �
<br /> VENTILATION $15. 00 each project �
<br /> No. � Kitchen Exhaust ducted recirculating cfm
<br /> No. � Bath Exhaust (must be ducted outside) ���C-,(�; cfm
<br /> cfm
<br /> No. i Other Fans: Locations ��f Total �Sb�'
<br /> _.r— �
<br /> ******************************************************************************** ;�
<br /> FIIEL STORAGE (must be approved by fire marshal ) ��
<br /> ' $30 . 00 Permanent/Temporary
<br /> Fuel oil, gallons underground inside outside
<br /> LP Gas, gallons
<br /> Other Gas opening �
<br /> ic�t**�k�k***�F***i��k**�ci�*�t*****�k***irir�c*****�c***�t****�t***�Y****�F*****i�***�k**�t********** ;%;;a
<br /> GAS LINE INSPECTION ii?x�
<br /> High/Low Pressure $15 . 00 ��'�'
<br /> � ��
<br /> ��*�*�****x�x��x**�;���x**�*:�**�*************************************************
<br /> PERMIT FEE CALCIILATION }
<br /> 1. Total of above Installations or Mini.mum Fee ($30.00) $ (p�J•��
<br /> 2 . State Surcharge. Add the State Building Code Division �
<br /> Surcharge to each permit $ . 50 �.�
<br /> 3. Postaqe and Handling on all mailed-in applications, S 1. 50 .�
<br /> 4 . TOTAL PERMIT FEE add lines 1-3 above $ �,�e' _ �
<br /> The undersigned hereby applies to the City of issuance of a Mechanical Permit, �
<br /> agrees to do all work in strict accordance with the ordinances of the City and �^
<br /> the regulations of the ota State Building Code, and certifies that all �
<br /> sta�e�tnt5 ma�e on th� ap`1?c _'on axe co _ ete, true and correct.
<br /> �
<br /> i"� �� �.
<br /> ,�.�
<br /> Applicant' s Signature:_ � Date: ��
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