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<br /> WOOD BURNING EOITIPMENT - �
<br /> = Wood stove with flue . -: , . : .- ..- - , - �_� _. _,:� ._�,,_ .;v �; i
<br /> . . : , . _ _ , ; __ ,
<br /> Wood combination or add-on _ L -�.��
<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. .�
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<br /> VENTILATION �
<br /> _ No. Kitchen Exhaust ducted recirculating cfm
<br /> - No. Bath Exhaust (must be ducted outside) cfm -
<br /> - ' No. Other Fans: Locations cfm
<br /> ;
<br /> - � FUEL STORAGE (1VIUST BE APPROVED BY FIRE MARSHAL)
<br /> - Installation Removal .
<br /> Fuel oil: gallons underground inside outside�
<br /> LP Gas: gallons �
<br /> Other Gas opening
<br /> PERMIT FEE CALCULATION �
<br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) �
<br /> 3sv�a �� X .oi2s � �� -�15
<br /> . (contract price) .
<br /> � 2. State Surchar�e. ** Add the State Building Code Division � ���-.. �
<br /> Surcharge to each permit. 3�""l)O � ��'v x .0005 $
<br /> or $.50, whichever is greater (contract price)
<br /> ,
<br /> 3. Posta�e and Handling (Only mail-in applicafions) $ 1.50 '
<br /> 4. TOTAL PERMIT FEE (Add lines 1-3 above) $ �� -l`�l� I
<br /> * CONTRACT PRICE or JOB COST means the actual or estimated dollar amount charged for the pernutted �
<br /> work including materials, labor, profit, and other fued 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, j
<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.
<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 j
<br /> all work in strict accordance with the ordinances of the City and the regulations of the Muinesota (
<br /> State Building Code, and certifies that all statements made on this application are complete, true
<br /> and correct. �
<br /> Applicant's Signature: ��-y--J , Date: ������
<br /> Approved By: Date:
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