Laserfiche WebLink
y , � <br /> _ _ _ .. _ _ . . -�_ <br /> WOOD BURNING EQLTIPMENT - - <br /> Wood stove with flue . � <br /> Wood combination or add-on _ _� <br /> Factory fireplace with flue � �/ � <br /> - Factory Fireplace (s) Freestanding . �\ Masanry . <br /> Wood Stove (s) Franklin, other " <br /> Brand Name Model No. <br /> Mfgr's Min., Clearances, side , rear , min. flue dia. <br /> Total <br /> VENTILATION <br /> No. Kitchen Exhaust ducted recirculating �� <br /> No. Bath Exhaust (must be ducted outside) �� <br /> No. Other Fans: Locations ��° � <br /> . Total <br /> FUEL STORAGE (MUST BE APPROVED BY FIlZE MARSHAI-) <br /> Installation Removal <br /> Fuel oil: gallons underground inside outside <br /> LP Gas: gallons <br /> Other Gas opening <br /> pERNiIT FEE CALCULATION <br /> 1. 1.25% of Contract Price* or Minimum Fee ($35.00) <br /> �S �S' � C%�% x .0125 $ <br /> (contract price) <br /> 2. State Surchar�e. ** Add the State Building Code DiXisio�5 � <br /> Surcharge to each permit. <br /> (contract price) <br /> or $.50, whichever is greater <br /> 3. Posta�e and Handlin� (Only mail-in applications) $ 1.50 <br /> 4. TOTAL PERNIIT FEE (Add lines 1-3 above) � <br /> * CONTRACI'PRICE or JOB COST means che actual or estimated dollar amount charged for the permitted <br /> woric including materials, labor, profit, and other fized cosu. 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 /> tenant or any other parry the reasonable market value of such items must be added to the estimated cost <br /> or contraci price for permit fee purposes. In the evenL that�erae�'�dispn�n the amount of the job cost, <br /> the City may request the submission of a signed copY <br /> ** The STATE SURCHARGE is .0005 of the contract price under $1,Q00,000 or �.50 - whichever is <br /> greatez. For valuations over $1,00O,OOo call the DePartment of Inspectional $ervices 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,���erti ie that all statements made on this application are complete, true <br /> ___ / / � <br /> and correct - -- � - � . <br /> .. _ _ . , _ � <br /> j` �/ - � Date: <br /> _ Applicant's Si <br /> � __ . Date: <br /> Approved By:.-..:_-: ' <br />